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Eur J Cardiothorac Surg 2007;31:22-25. doi:10.1016/j.ejcts.2006.07.027
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Endoscopic off-pump aortic valve replacement: does the pericardial cuff improve the sutureless closure of left ventricular access?

^a Cardiovascular Surgery Department, University of Lausanne CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland
^b Department of Pediatric Radiology, University of Medical Science, Pozna, Poland
^c Department of Veterinary Medicine, University of Agricolture, Pozna, Poland

Received 3 April 2006; received in revised form 25 June 2006; accepted 4 July 2006.

^_* Corresponding author. Tel.: +41 21 314 23 08; fax: +41 21 314 22 78. (Email: Piergiorgio.Tozzi{at}hospvd.ch).

Objective: Off-pump trans left ventricular approach provides more precise deployment of stented aortic valve of any size with respect to the endovascular replacement. One of the key steps of this procedure is the ventricle repair after catheter withdrawing. We designed an animal study to compare the consistency of a sutureless repair of the left ventricle access using nitinol occluder with and without pericardial cuff on the ventricular side. Methods: Material description: The Amplatz-nitinol occluder consists of two square heads squeezing ventricle wall in between them, sealing the defect. To improve its sealing property, a pericardial patch was sutured to the ventricular head of the occluder. Animal study setup: In adult pigs, a 30F sheath was inserted into the epigastric area through the cardiac apex, up to the left ventricle, simulating the approach for off-pump aortic valve replacement. The sheath was then removed and the ventricle closed with standard occluder in half of the animals, and cuffed occluder in the other half. Animals were followed-up for 3 h, collecting haemodynamics data and pericardial bleeding. Results: Device was successfully deployed in 12 animals in less than 1 min. In the group where the standard occluder was used, bleeding during the deployment was 80 ± 20 ml and after the deployment was 800 ± 20 ml over 3 h. In the group where the cuffed occluder was used, bleeding during the deployment was 85 ± 20 ml and after the deployment was 100 ± 5 ml over 3 h. In the cuffed group, bleeding was significantly lower than the standard group, p-value being <0.001. Conclusions: The occluder is easy to use and the pericardial cuff dramatically increases its efficacy as demonstrated by a significant reduction of blood loss. The cuffed occluder opens the way for endoscopic, off-pump, transventricular aortic valve replacement.

Key Words: Aortic valve replacement • Stented aortic valve • Suturless closure cardiac defects

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