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Eur J Cardiothorac Surg 2006;30:379
© 2006 Elsevier Science NL

Images in cardio-thoracic surgery

Percutaneous valve replacement: a novel low-profile polyurethane valved stent

Tim Attmanna, Ulrich Steinseiferb, Jochen Cremera, Georg Luttera,*

a Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 7, D-24105 Kiel, Germany
b Helmholtz-Institute, RWTH Aachen, Applied Medical Engineering, Pauwelsstr. 20, D-52074 Aachen, Germany

Received 31 January 2006; received in revised form 9 April 2006; accepted 26 April 2006.

* Corresponding author. Tel.: +49 431 597 4401; fax: +49 431 597 4402. (Email: lutter{at}kielheart.uni-kiel.de).

Key Words: Heart valve • Percutaneous • Pulmonary valve • Endovascular stent

To circumvent size restrictions of percutaneous heart valves, we designed a novel low-profile valved stent made of polyurethane which fits into a 14-French delivery device (Fig. 1 ). Transfemoral implantation in pulmonary position was evaluated in two sheep. Competent valves with low gradients were seen at the 1-month follow-up (Fig. 2 ).


Figure 1
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  		Fig. 1. (a) Oblique view from top of a self-expanding nitinol stent (length 28 mm, diameter 24 mm, Nitinol Devices & Components Inc., Fremont, CA, USA) containing a three leaflet polyurethane valve. Leaflets have a thickness of approximately 100–150 µm. The stent valves are produced in a dip coating technique (by Mecora GmbH, Aachen, Germany). (b) Low-profile polyurethane valved stent was folded to fit into a 14-French catheter. A modified commercially available endovascular stent-graft system for the treatment of abdominal and thoracic aortic aneurysms (Medtronic, TalentTM, Santa Rosa, CA, USA) served as delivery device. The intervention was performed as described previously (Attmann, Lutter et al., Ann Thorac Surg 2005;80:969–75).

 

Figure 2
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  		Fig. 2. Angiography of the pulmonary artery one month after valved stent implantation. Pictures in chronological order from (a) to (d). Catheter-induced mild pulmonary insufficiency. Daebritz et al. (Eur J Cardiothorac Surg 2004;25:946–52) were able to show that a surgically implanted flexible polymeric heart valve prosthesis was superior to current bioprostheses in animal testing. The durability of our new stent-mounted polyurethane valve needs to be corroborated. Repetitive follow-up assessment will be continuously performed for determination of the long-term functioning and durability.

 

Acknowledgments

Dr Lutter's project of percutaneous valve replacement is supported by the German Research Foundation, Bonn, Germany (Grant LU 663/4-1, LU 663/4-2). We gratefully thank Mr J. Hutzenlaub, Mecora GmbH, Aachen, Germany for the development and production of the polyurethane valves.




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Off-pump aortic valve replacement with catheter-mounted valved stents.: Is the future already here?
Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 1 - 3.
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