HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Christoph H. Huber Antonio F. Corno Patrick Ruchat Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Huber, C. H. Articles by von Segesser, L. K. Search for Related Content PubMed PubMed Citation Articles by Huber, C. H. Articles by von Segesser, L. K. Related Collections Minimally invasive surgery Valve disease

Eur J Cardiothorac Surg 2004;25:754-759
© 2004 Elsevier Science NL

Do valved stents compromise coronary flow?

Service de Chirurgie Cardiovasculaire, Centre Hospitalier Universitaire Vaudois CHUV, 1011 Lausanne, Switzerland

Received 22 October 2003; received in revised form 14 January 2004; accepted 23 January 2004.

^* Corresponding author. Tel.: +41-21-3142310; fax: +41-21-3142278
e-mail: huberch{at}dr.com

Objective: The aim of the present study is to evaluate a new self-expanding valved stent design for minimal invasive aortic valve implantation and its interference with coronary flow. Methods: An equine pericardial valve mounted onto a self-expanding nitinol stent (3F Therapeutics^TM, CA, USA), outer diameter 23 mm, was evaluated (A) in vitro in a dynamic pulsatile mock loop and (B) in vivo in six calves (75±2.5 kg). In four animals valve stents were implanted on-pump and in two animals off-pump after induction of ventricular fibrillation. Target site for deployment was the orthotopic aorta, over the native valves. In vivo assessment was performed with intracardiac (AcuNav^TM) and intravascular ultrasound including leaflet motion, planimetric valve orifice and residual-coronary\sinus-stent-index (RCSSI, distance stent to aortic wall/coronary diameter) calculations, coronary blood flow characteristics, transvalvular gradient, regurgitation and paravalvular leaking, in combination with continuous cardiac output measures. Macroscopic analysis was performed at necropsy. Results: Two-dimensional intracardiac ultrasound showed good leaflet motion, with full valvular opening and closing in five of six valves. Planimetric valve orifice was 1.75±0.4 cm². There were no signs of coronary flow impairment with an RCSSI of 1.8±1.2. The implanted valved stents showed a low transvalvular gradient of 5.3±3.9 mmHg (mean, peak-to-peak) on invasive measurements and 4.7±2.5 mmHg in two-dimensional intracardiac sonography. One of six valves showed mild to moderate regurgitation and one of six valves a minor to moderate paravalvular leak due to size mismatch. Conclusions: This new self-expanding valved stent design allows for on- and off-pump aortic valve implantation in the orthotopic aorta, over the native valves without interference of the coronary blood flow and excellent acute valve function in properly sized devices.

Key Words: Aortic valve implantation • Valved stents • Prosthesis • Valves

This article has been cited by other articles:

				S. Salizzoni, P. Bajona, K. J. Zehr, W. D. Anderson, S. Vandenberghe, and G. Speziali Transapical off-pump removal of the native aortic valve: a proof-of-concept animal study. J. Thorac. Cardiovasc. Surg., August 1, 2009; 138(2): 468 - 473. [Abstract] [Full Text] [PDF]

				M. J. Davidson and D. S. Baim Percutaneous Aortic Valve Interventions Card. Surg. Adult, January 1, 2008; 3(2008): 963 - 971. [Full Text]

				T. Walther, P. Simon, T. Dewey, G. Wimmer-Greinecker, V. Falk, M. T. Kasimir, M. Doss, M. A. Borger, G. Schuler, D. Glogar, et al. Transapical Minimally Invasive Aortic Valve Implantation: Multicenter Experience Circulation, September 11, 2007; 116(11_suppl): I-240 - I-245. [Abstract] [Full Text] [PDF]

				C. H. Huber, B. Marty, and L. K. von Segesser Acceptance and introduction of disruptive technologies simple steps to build a fully functional pulmonary valved stent Interactive CardioVascular and Thoracic Surgery, August 1, 2007; 6(4): 430 - 432. [Abstract] [Full Text] [PDF]

				T. Walther and F. W. Mohr Aortic valve surgery: time to be open-minded and to rethink Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 4 - 6. [Full Text] [PDF]

				T. Walther, V. Falk, M. A. Borger, T. Dewey, G. Wimmer-Greinecker, G. Schuler, M. Mack, and F. W. Mohr Minimally invasive transapical beating heart aortic valve implantation -- proof of concept Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 9 - 15. [Abstract] [Full Text] [PDF]

				P. Tozzi, M. Pawelec-Wojtalic, D. Bukowska, V. Argitis, and L. K. von Segesser Endoscopic off-pump aortic valve replacement: does the pericardial cuff improve the sutureless closure of left ventricular access? Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 22 - 25. [Abstract] [Full Text] [PDF]

				L. K. von Segesser Closure devices: the solution for repair of direct access apertures after valved stent implantation? Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 2 - 3. [Full Text] [PDF]

				T. Walther, T. Dewey, G. Wimmer-Greinecker, M. Doss, R. Hambrecht, G. Schuler, F. W. Mohr, and M. Mack Transapical approach for sutureless stent-fixed aortic valve implantation: experimental results. Eur. J. Cardiothorac. Surg., May 1, 2006; 29(5): 703 - 708. [Abstract] [Full Text] [PDF]

				L. Ma, P. Tozzi, C. H. Huber, S. Taub, G. Gerelle, and L. K. von Segesser Double-crowned valved stents for off-pump mitral valve replacement Eur. J. Cardiothorac. Surg., August 1, 2005; 28(2): 194 - 198. [Abstract] [Full Text] [PDF]

				C. H. Huber, L. H. Cohn, and L. K. von Segesser Direct-Access Valve Replacement: A Novel Approach for Off-Pump Valve Implantation Using Valved Stents J. Am. Coll. Cardiol., July 19, 2005; 46(2): 366 - 370. [Abstract] [Full Text] [PDF]

				M. Pawelec-Wojtalik, L. K. von Segesser, M. Liang, and D. Bukowska Closure of left ventricle perforation with the use of muscular VSD occluder Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 714 - 716. [Abstract] [Full Text] [PDF]

				G. Lutter, R. Ardehali, J. Cremer, and P. Bonhoeffer Percutaneous Valve Replacement: Current State and Future Prospects Ann. Thorac. Surg., December 1, 2004; 78(6): 2199 - 2206. [Abstract] [Full Text] [PDF]

				L. K. von Segesser, B. Marty, P. Tozzi, and P. Ruchat Impact of endoluminal stenting for aortic surgery Eur. J. Cardiothorac. Surg., December 1, 2004; 26(Suppl_1): S14 - S18. [Abstract] [Full Text] [PDF]

				L. K. von Segesser Direct percutaneous valve replacement: the next step? Eur. J. Cardiothorac. Surg., November 1, 2004; 26(5): 873 - 874. [Full Text] [PDF]

				M. Pawelec-Wojtalik, P. Antosik, G. Wasiatycz, and M. Wojtalik Use of muscular VSD Amplatzer occluder for closing right ventricular free wall perforation after hybrid procedure Eur. J. Cardiothorac. Surg., November 1, 2004; 26(5): 1044 - 1046. [Abstract] [Full Text] [PDF]