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Percutaneous aortic valve replacement: gross anatomy and histological findings after transapical and endoluminal resection of human aortic valves in situ

^a Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 7, D-24105 Kiel, Germany
^b Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
^c Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany

Received 4 September 2008; received in revised form 14 March 2009; accepted 18 March 2009.

^_* Corresponding author. Tel.: +49 431 597 4581; fax: +49 431 597 4402. (Email: lutter{at}kielheart.uni-kiel.de).

Objective: Transluminal resection of the aortic valve was already successfully carried out by our group. The aim of this study was the analysis of the gross anatomy and the histology of the surrounding tissue after resection. Methods: Aortic valve resection was performed in postmortem human hearts (endoluminal (EL) n = 9, transapical (TA) n = 4). After deployment of the aortic valve isolation chamber, the leaflets were resected with a Thullium:YAG laser scalpel (cw, 20 W). After resection, the hearts were analyzed to check for lesions caused by resectioning the associated tools. Therefore, gross anatomy and histological analysis were performed (H&E staining). Results: Lesions of the aortic annulus were seen in 3/9 (EL) (depth: 583 ± 186 µm) and 2/4 (TA) (120 µm and one complete perforation), lesions of the aorta (ascending-arch-descending) in 4-9-0/9 (EL) and 0-0-0/4 (TA), lesions of the mitral valve in 0/9 (EL) and 0/4 (TA), lesions of the papillary muscle in 0/9 (EL) and 2/4 (TA) (depth: 400 µm and 450 µm), lesions of the endomyocardium in 0/9 (EL) and 4/4 (TA) (depth: 258 ± 102 µm). The coronary ostia remained unaffected. Conclusions: This study shows fewer severe lesions in the aorta after transapical antegrade access compared to the transluminal retrograde approach. Especially noteworthy is that the aortic arch remains unaffected by the transapical procedure. These data demonstrate the transapical approach as less hazardous.

Key Words: Resection • Histology • Percutaneous • Endovascular • Transapical • Human • Aortic valve • In situ