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Eur J Cardiothorac Surg 2009;35:970-976. doi:10.1016/j.ejcts.2009.01.052
Copyright © 2009, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Roland Henaine
Martins Kalejs
Enrico Ferrari
Jean-Francois Obadia
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A new self-expanding aortic stent valve with annular fixation: in vitro haemodynamic assessment

Mathieu Vergnat*, Roland Henaine, Martins Kalejs, Sandra Bommeli, Enrico Ferrari, Jean-Francois Obadia, Ludwig Karl Von Segesser

Department of Cardio-Vascular Surgery, CHUV, Lausanne, Switzerland

Received 31 August 2008; received in revised form 2 January 2009; accepted 7 January 2009.

* Corresponding author. Address: Service de Chirurgie Cardio-Vasculaire et Transplantation C, Hôpital Cardiothoracique Louis Pradel, 28 Avenue du Doyen Lépine, Lyon-Bron, 69677, France. Tel.: +33 4 72 35 75 46; fax: +33 4 72 35 73 83. (Email: mathieu.vergnat{at}chu-lyon.fr).

Objective: Balloon-expandable stent valves require flow reduction during implantation (rapid pacing). The present study was designed to compare a self-expanding stent valve with annular fixation versus a balloon-expandable stent valve. Methods: Implantation of a new self-expanding stent valve with annular fixation (Symetis®, Lausanne, Switzerland) was assessed versus balloon-expandable stent valve, in a modified Dynatek Dalta® pulse duplicator (sealed port access to the ventricle for transapical route simulation), interfaced with a computer for digital readout, carrying a 25 mm porcine aortic valve. The cardiovascular simulator was programmed to mimic an elderly woman with aortic stenosis: 120/85 mmHg aortic pressure, 60 strokes/min (66.5 ml), 35% systole (2.8 l/min). Results: A total of 450 cardiac cycles was analysed. Stepwise expansion of the self-expanding stent valve with annular fixation (balloon-expandable stent valve) resulted in systolic ventricular increase from 120 to 121 mmHg (126 to 830 ± 76 mmHg)*, and left ventricular outflow obstruction with mean transvalvular gradient of 11 ± 1.5 mmHg (366 ± 202 mmHg)*, systolic aortic pressure dropped distal to the valve from 121 to 64.5 ± 2 mmHg (123 to 55 ± 30 mmHg) N.S., and output collapsed to 1.9 ± 0.06 l/min (0.71 ± 0.37 l/min* (before complete obstruction)). No valve migration occurred in either group. (* = p < 0.05). Conclusions: Implantation of this new self-expanding stent valve with annular fixation has little impact on haemodynamics and has the potential for working heart implantation in vivo. Flow reduction (rapid pacing) is not necessary.

Key Words: Percutaneous valve replacement • Aortic valve replacement • Valved stent • Transcatheter valve replacement • Self-expandable valved stent • Balloon-expandable valved stent






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Copyright © 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.