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In vitro results of a new minimally invasive aortic valve resecting tool

^a Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Essen, Germany
^b Endosmart GmbH, Stutensee, Germany
^c Department of Physical Engineering, Fachhochschule Gelsenkirchen, Gelsenkirchen, Germany

Received 2 September 2008; received in revised form 3 January 2009; accepted 7 January 2009.

^_* Corresponding author. Address: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Hufelandstraße 55, 45122 Essen, Germany. Tel.: +49 201 723 84912; fax: +49 201 723 5451. (Email: daniel.wendt{at}uk-essen.de).

Background: Aortic valve replacement (AVR) using extracorporeal circulation is currently the treatment of choice for symptomatic aortic stenosis. However, patients with multiple high-risk comorbid conditions may benefit from reduced ECC time by a simplified and faster resection in conjunction with quick sutureless valve implantation. Methods: A prototype of a new minimally invasive aortic valve resection tool equipped with rotating and foldable Nitinol cutting edges was designed. Commercially available aortic valve bioprostheses were artificially calcified (group 1: moderate calcified, n = 8, group 2: severely calcified, n = 8). In vitro resection was performed using a 21 mm cutting blade. Resection time (RT), maximum turning moment (MTM) and number of required rotations (NR) were measured. Furthermore, particle generation during the process of cutting was obtained and quantified. Results: Aortic valve cutting could be obtained without any complications in all cases. Cutting process resulted in a RT of 15.5 ± 3 s in group 1 compared to 34.9 ± 15 s in group 2 (p = 0.005), MTM was 3 ± 0.6 N m in group 1 compared to 3.5 ± 0.6 N m in group 2 (p = 0.068) and NR were 30.6 ± 2.3 in group 1 compared to 48.1 ± 15.5 in group 2 (p = 0.007). Particle generation was 1.77 ± 0.17 g in group 1 compared to 1.41 ± 0.44 g in group 2 (p = 0.047). Conclusions: These first in vitro results confirm feasibility and accelerated aortic valve resection within 30 s. This new concept holds promise for very fast AVR in combination with insertion of sutureless aortic valve prosthesis, targeting for ischemic times less than 10 min in the open heart situation. Finally, resection and percutaneous AVR within 1 min in the beating heart situation is envisioned.

Key Words: Aortic valve • Aortic valve resection • Resection tool • Percutaneous valve implantation

This article has been cited by other articles:

				D. Wendt, S. Stuhle, H. Wendt, M. Thielmann, B. Kipfmuller, F. Hauck, B. Vogel, and H. Jakob Cutting precision in a novel aortic valve resection tool. Research in progress Interactive CardioVascular and Thoracic Surgery, October 1, 2009; 9(4): 672 - 676. [Abstract] [Full Text] [PDF]