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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joerg Kempfert Michael W.A. Chu Volkmar Falk Friedrich W. Mohr Thomas Walther Permission Requests Google Scholar Articles by Kempfert, J. Articles by Walther, T. PubMed Articles by Kempfert, J. Articles by Walther, T. Related Collections Minimally invasive surgery Valve disease

Minimally invasive off-pump valve-in-a-ring implantation: the atrial transcatheter approach for re-operative mitral valve replacement after failed repair

Department of Cardiac Surgery, Heartcenter, University of Leipzig, Leipzig, Germany

Received 8 September 2008; received in revised form 18 January 2009; accepted 2 February 2009.

^_* Corresponding author. Address: Herzzentrum Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany. Tel.: +49 341 8650; fax: +49 341 8651052. (Email: kempfert{at}web.de).

Objective: Based upon recent developments in transcatheter technology, this study was designed to evaluate the feasibility and haemodynamic performance of transcatheter valve-in-a-ring (VinR) implantation for potentially failed mitral repair using a minimally invasive, transatrial, off-pump approach. Methods: Adult sheep (54.3 ± 3.0 kg) underwent mitral valve repair with a 26 mm complete annuloplasty ring (Physio^TM) using standard conventional techniques. To simulate the redo operation, a transcatheter 23 mm pericardial prosthesis (Edwards Sapien^TM) mounted on a balloon-inflatable steel stent was deployed within the annuloplasty ring. VinR implantation was performed off-pump under rapid pacing in four and on-pump in three animals using an antegrade transatrial approach under fluoroscopic guidance. Results: Transcatheter VinR implantation was successful in all seven sheep. Mean transvalvular gradient was 4.9 ± 0.3 mmHg. VinR function was excellent with no leak in one, good with mild leak in five (trans-stent: four, paravalvular: one) and sufficient with moderate central leak in one animal, respectively. Valve deployment required 10.0 ± 0.7 min and all transcatheter prostheses were confirmed in good position on postmortem analysis, without any signs of valve dislocation or embolisation. In an in-vitro model, the minimum force required to dislodge the valve was 32.9 ± 5.2 N, which was well above the normal estimated forces generated by the left ventricle. One animal was kept alive to assess mid-term outcome and is still well 12 months after the VinR implantation. Conclusions: Transatrial, transcatheter mitral VinR implantation is feasible using a minimally invasive off-pump approach. VinR implantation is a promising concept for re-operative surgery for selected patients after failed mitral valve repair.

Key Words: Mitral valve • Minimally invasive • Transcatheter valves • Redo surgery