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Poschner T, Werner P, Kocher A, Laufer G, Musumeci F, Andreas M, Russo M. The JenaValve pericardial transcatheter aortic valve replacement system to treat aortic valve disease. Future Cardiol 2021; 18:101-113. [PMID: 34647465 DOI: 10.2217/fca-2021-0065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Transcatheter aortic valve replacement is a valuable alternative technique to surgery and the spectrum of therapy continues to evolve. The JenaValve Pericaridal transcatheter aortic valve replacement System allows prosthesis fixation in a native, noncalcified aortic annulus with a unique paper clip-like anchorage mechanism. The low rate of paravalvular leakage and permanent pacemaker implantation emphasizes the further widespread use of the JenaValve - despite the limited data available. In May 2021, a CE mark for the transfemoral implantation in both aortic regurgitation and aortic stenosis was granted. However, no data have been published so far. The ongoing ALIGN trials are expected to provide the pending long-term data.
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Affiliation(s)
- Thomas Poschner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Paul Werner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Francesco Musumeci
- Department of Cardiac Surgery & Heart Transplantation, San Camillo Forlanini Hospital of Rome, Rome, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Marco Russo
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria.,Department of Cardiac Surgery & Heart Transplantation, San Camillo Forlanini Hospital of Rome, Rome, Italy
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Kan T, Gu L, Lu H, Cao J, Zhu Z, Wu D, Zhu Z, Chen X. Improved Transcatheter aortic valve implantation for aortic regurgitation using a new-type stent: the first preclinical experience. J Cardiothorac Surg 2020; 15:276. [PMID: 32993717 PMCID: PMC7525934 DOI: 10.1186/s13019-020-01327-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study, we sought to evaluate the feasibility of improved transcatheter aortic valve implantation (TAVI) in noncalcified aortic valve by using the novel concept of double-layer ChenValve prosthesis. TAVI was initially considered as an alternative treatment for high-risk patients with aortic stenosis. However, non noncalcified aortic valve disease was considered as a contraindication to TAVI. METHODS ChenValve prosthesis, which consisted of a self-expanding Nitinol ring, a balloon-expandable cobalt-chromium alloy stent and a biological valve, was implanted at the desired position under fluoroscopic guidance in a transapical approach through a 20F sheath in 10 goats. Aortic angiography was performed to measure the diameter of the aotic annulus and assess the performance of the artificial valve. The ultrasound was used to evaluate the regurgitation or paravalvular leakage and trans-prosthetic vascular flow velocity postoperatively. The aortogram and transthoracic echocardiography were applied to observe whether the valve stent was implanted at the desired position. RESULTS ChenValve prosthesis was successfully transppical implanted in all animals. The aortogram and transthoracic echocardiography performed immediately after implantation revealed that the valve stent was implanted at the desired position. There was no significant paravalvular leakage, obstruction of coronary artery ostia, stent malpositioning or dislodgement occurred. CONCLUSIONS This preliminary trial with the novel double-layer ChenValve prosthesis demonstrated the feasibility of improved TAVI in noncalcified aortic valve. The mechanism of Nitinol ring-guided locating the aortic sinus enables us to anatomically correct position the artifact valve. This improved strategy seems to make the TAVI process more safe and repeatable in noncalcified aortic valve.
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Affiliation(s)
- Tong Kan
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Lan Gu
- Department of Cardiology, ShangRao Hospital of Traditional Chinese Medicine, Shangrao, 334000, Jiangxi, China
| | - Hongjiang Lu
- Department of medical image, The 903 Hospital of the Chinese People's Liberation Army, Hangzhou, 310004, Zhejiang, China
| | - Junxiong Cao
- Department of Cardiology, The 903 Hospital of the Chinese People's Liberation Army, No. 40 JiChang Road, Jianggang District, Hangzhou, 310004, Zhejiang Province, China
| | - Zhijun Zhu
- Department of Cardiology, The 903 Hospital of the Chinese People's Liberation Army, No. 40 JiChang Road, Jianggang District, Hangzhou, 310004, Zhejiang Province, China
| | - Danning Wu
- Department of Cardiology, The 903 Hospital of the Chinese People's Liberation Army, No. 40 JiChang Road, Jianggang District, Hangzhou, 310004, Zhejiang Province, China
| | - Zhidong Zhu
- Department of Cardiology, The 903 Hospital of the Chinese People's Liberation Army, No. 40 JiChang Road, Jianggang District, Hangzhou, 310004, Zhejiang Province, China
| | - Xiang Chen
- Department of Cardiology, The 903 Hospital of the Chinese People's Liberation Army, No. 40 JiChang Road, Jianggang District, Hangzhou, 310004, Zhejiang Province, China.
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Silaschi M, Treede H, Rastan AJ, Baumbach H, Beyersdorf F, Kappert U, Eichinger W, Rüter F, de Kroon TL, Lange R, Ensminger S, Wendler O. The JUPITER registry: 1-year results of transapical aortic valve implantation using a second-generation transcatheter heart valve in patients with aortic stenosis. Eur J Cardiothorac Surg 2016; 50:874-881. [PMID: 27242354 DOI: 10.1093/ejcts/ezw170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/09/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve replacement (TAVR) is an established therapy for patients with aortic stenosis (AS) at high surgical risk. The JenaValve™ is a second-generation, self-expanding transcatheter heart valve (THV), implanted through transapical access (TA). During stent deployment, a specific 'clipping-mechanism' engages native aortic valve cusps for fixation. We present 1-year outcomes of the JUPITER registry, a post-market registry of the JenaValve for TA-TAVR. METHODS The JUPITER registry is a prospective, multicentre, uncontrolled and observational European study to evaluate the long-term safety and effectiveness of the Conformité Européenne-marked JenaValve THV. A total of 180 patients with AS were enrolled between 2012 and 2014. End-points were adjudicated in accordance with the valve academic research consortium document no. 1 definitions. RESULTS The mean age was 80.4 ± 5.9 years and the mean logistic European system for cardiac operative risk evaluation I 21.2 ± 14.7%. The procedure was successful in 95.0% (171/180), implantation of a second THV (valve-in-valve) was performed in 2.2% (4/180) and conversion to surgical aortic valve replacement (SAVR) was necessary in 2.8% (5/180). No annular rupture or coronary ostia obstruction occurred. Two patients required SAVR after the day of index procedure (1.1%). All-cause mortality at 30 days was 11.1% (20/180), being cardiovascular in 7.2% (13/180). A major stroke occurred in 1.1% (2/180) at 30 days, no additional major strokes were observed during 1 year. All-cause mortality after 30 days was 13.1% (21/160) and combined efficacy at 1 year was 80.8% (122/151). At 1-year follow-up, no patient presented with more than moderate paravalvular leakage, while 2 patients (3.2%) showed moderate, 12 (19.0%) mild and 49 (82.4%) trace/none paravalvular regurgitation. CONCLUSIONS In a high-risk cohort of patients undergoing TA-TAVR for AS, the use of the JenaValve THV is safe and effective. In patients at higher risk for coronary ostia obstruction, annular rupture or with limited aortic valve calcification, the JenaValve might be preferable for implantation due to its clipping-mechanism engaging native aortic valve cusps for fixation with reduced radial forces of the self-expanding stent.
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Affiliation(s)
- Miriam Silaschi
- Department of Cardiothoracic Surgery, King's College Hospital London, London, UK
| | - Hendrik Treede
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Ardawan J Rastan
- Department of Cardiac Surgery, Center of Cardiovascular Diseases Rotenburg a. d. Fulda, Rotenburg, Germany
| | - Hardy Baumbach
- Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery Freiburg, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Walter Eichinger
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Germany
| | - Florian Rüter
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Thomas L de Kroon
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich at Technische Universität München, Munich, Germany
| | - Stephan Ensminger
- Department of Cardiothoracic Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital London, London, UK
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Liu X, Tang Y, Luo F, Tian Y, Li K, Sun J, Jia L, Wang W. Transapical implantation of a self-expandable aortic valve prosthesis utilizing a novel designed positioning element. Catheter Cardiovasc Interv 2016; 89:E30-E37. [DOI: 10.1002/ccd.26429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 12/31/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Xiaopeng Liu
- Center of Cardiac Surgery for Adults, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 People's Republic of China
- Animal experimental center & Beijing Key Laboratory of Pre-clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 People's Republic of China
| | - Yue Tang
- Center of Cardiac Surgery for Adults, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 People's Republic of China
- Animal experimental center & Beijing Key Laboratory of Pre-clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 People's Republic of China
| | - Fuliang Luo
- Animal experimental center & Beijing Key Laboratory of Pre-clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 People's Republic of China
| | - Yi Tian
- Animal experimental center & Beijing Key Laboratory of Pre-clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 People's Republic of China
| | - Kai Li
- Center of Cardiac Surgery for Adults, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 People's Republic of China
| | - Jiakang Sun
- Animal experimental center & Beijing Key Laboratory of Pre-clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 People's Republic of China
| | - Liujun Jia
- Animal experimental center & Beijing Key Laboratory of Pre-clinical Research and Evaluation for Cardiovascular Implant Materials, State Key Laboratory of Cardiovascular Disease; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 People's Republic of China
| | - Wei Wang
- Center of Cardiac Surgery for Adults, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 People's Republic of China
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Lauten A, Gerhard-Garcia A, Suhr F, Fischer JH, Figulla HR, Bloch W. Impact of ischemia-reperfusion on extracellular matrix processing and structure of the basement membrane of the heart. PLoS One 2014; 9:e92833. [PMID: 24681713 PMCID: PMC3969375 DOI: 10.1371/journal.pone.0092833] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 02/26/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Acute ischemic injury is a strong inductor of cardiac remodelling, resulting in structural changes of the extracellular matrix (ECM) and basement membrane (BM). In a large animal model of ischemia-reperfusion (I/R) we investigated the post-ischemic liberation of the collagen-IV-fragments Tumstatin (TUM; 28 kDa-fragment of collagen-IV-alpha-3), Arresten (ARR; 26 kDa-fragment of collagen-IV-alpha-1) and Endorepellin (LG3, 85 kDa-fragment of perlecan) which are biologically active in angiogenesis and vascularization in the post-ischemic myocardium. METHODS AND RESULTS In this blinded study, 30 pigs were randomized to 60 min of global I/R at either 4°C or 32°C or served as control. Three transmyocardial tissue samples were collected prior to ischemia and within 30 min and 150 min of reperfusion. Tissue content of TUM, ARR and LG3 was analyzed by western blotting and immunostaining. Within 150 min of mild hypothermic I/R a significantly increased tissue content of ARR (0.17±0.14 vs. 0.56±0.56; p = 0.001) and LG3 (1.13±0.34 vs. 2.51±1.71, p<0.001) was observed. In contrast, deep hypothermic I/R was not associated with a significant release of cleavage products. Cleavage of TUM remained unchanged irrespective of temperature. Increased matrix processing following mild hypothermia I/R is further supported by a >11fold elevation of creatine kinase (2075±2595 U/l vs. 23248±6551 U/l; p<0.001) in the coronary sinus plasma samples. Immunostaining demonstrated no changes for ARR and LG3 presentation irrespective of temperature. In contrast, TUM significantly decreased in the BM surrounding cardiomyocytes and capillaries after mild and deep hypothermic I/R, thus representing structural alterations of the BM in these groups. CONCLUSION The study demonstrates an early temperature-dependent processing of Col-IV as major component of the BM of cardiomyocytes and vascular endothelium. These observations support the protective effects of deep hypothermia during I/R. Furthermore, the results suggest an increased structural remodelling of the myocardial basement membrane with potential functional impairment during mild hypothermic I/R which may contribute to the progression to post-ischemic heart failure.
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Affiliation(s)
- Alexander Lauten
- Department of Internal Medicine I (Cardiology, Angiology, Pneumology), Friedrich- Schiller University, Jena, Germany
- Institute of Cardiovascular Research and Sports Medicine, German Sports University, Cologne, Germany
- * E-mail:
| | - Alexandra Gerhard-Garcia
- Institute of Cardiovascular Research and Sports Medicine, German Sports University, Cologne, Germany
| | - Frank Suhr
- Institute of Cardiovascular Research and Sports Medicine, German Sports University, Cologne, Germany
| | - Juergen H. Fischer
- Institute for Experimental Medicine, University of Cologne, Cologne, Germany
| | - Hans R. Figulla
- Department of Internal Medicine I (Cardiology, Angiology, Pneumology), Friedrich- Schiller University, Jena, Germany
| | - Wilhelm Bloch
- Institute of Cardiovascular Research and Sports Medicine, German Sports University, Cologne, Germany
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Abstract
The JenaValve is a next-generation TAVI device which consists of a well-proven porcine root valve mounted on a low-profile nitinol stent. Feeler guided positioning and clip fixation on the diseased leaflets allow for anatomically correct implantation of the device without rapid pacing. Safety and efficacy of transapical aortic valve implantation using the JenaValve were evaluated in a multicentre prospective study that showed good short and midterm results. The valve was CE-mark released in Europe in September 2011. A post-market registry ensures on-going and prospective data collection in "real-world" patients. The transfemoral JenaValve delivery system will be evaluated in a first-in-man study in the near future.
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Affiliation(s)
- Hendrik Treede
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
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Li K, Wang Q, Pham T, Sun W. Quantification of structural compliance of aged human and porcine aortic root tissues. J Biomed Mater Res A 2013; 102:2365-74. [PMID: 23894117 DOI: 10.1002/jbm.a.34884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 07/15/2013] [Indexed: 11/08/2022]
Abstract
The structural compliance of the aortic root has a significant implication for valve procedures such as transcatheter aortic valve implantation and valve-sparing aortic root replacement. However, a detailed quantification of human aortic root structural compliance, particularly in different regions, has been incomplete. In this study, the structural properties of human aortic roots (81 ± 8.74 years, n = 10) were characterized and compared with those of porcine ones (6-9 months, n = 10) using a vessel pressure-inflation test. The test involved tracking three-dimensional deformation of the markers affixed on the different surface regions of the aortic roots, including the three sinuses: the noncoronary sinus (NCS), the left-coronary sinus (LCS), and the right-coronary sinus (RCS), and at three regions along the longitudinal direction of each sinus: the upper sinus (US), the middle sinus (MS), and the lower sinus (LS), and the ascending aorta (AA) region above the NCS. We found that tissue stiffness in physiological pressure range was similar among the three human sinuses. A variation in regional structural stiffness of human aorta was observed. In the circumferential direction, the LS regions were the stiffest in the LCS and RCS, whereas NCS had relatively uniform stiffness. In the longitudinal direction, the human AA regions were more compliant than all sinuses. There was a significant difference in tissue stiffness between human and porcine aortic tissues, suggesting that the mechanical properties of porcine tissues may not be analogous to aged human ones.
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Affiliation(s)
- Kewei Li
- Tissue Mechanics Laboratory, Biomedical Engineering Program and Department of Mechanical Engineering, University of Connecticut, Storrs, Connecticut, 06269
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Seiffert M, Diemert P, Koschyk D, Schirmer J, Conradi L, Schnabel R, Blankenberg S, Reichenspurner H, Baldus S, Treede H. Transapical Implantation of a Second-Generation Transcatheter Heart Valve in Patients With Noncalcified Aortic Regurgitation. JACC Cardiovasc Interv 2013; 6:590-7. [DOI: 10.1016/j.jcin.2013.01.138] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/01/2013] [Accepted: 01/03/2013] [Indexed: 10/26/2022]
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Mummert J, Sirois E, Sun W. Quantification of biomechanical interaction of transcatheter aortic valve stent deployed in porcine and ovine hearts. Ann Biomed Eng 2012; 41:577-86. [PMID: 23161165 DOI: 10.1007/s10439-012-0694-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 11/02/2012] [Indexed: 01/03/2023]
Abstract
Success of the deployment and function in transcatheter aortic valve replacement is heavily reliant on the tissue-stent interaction. The present study quantified important tissue-stent contact variables of self-expanding transcatheter aortic valve stents when deployed into ovine and porcine aortic roots, such as the stent radial expansion force, stent pullout force, the annulus deformation response and the coefficient of friction on the tissue-stent contact interface. Braided Nitinol stents were developed, tested to determine stent crimped diameter vs. stent radial force from a stent crimp experiment, and deployed in vitro to quantify stent pullout, aortic annulus deformation, and the coefficient of friction between the stent and the aortic tissue from an aortic root-stent interaction experiment. The results indicated that when crimped at body temperature from 26 mm to 19, 21 and 23 mm stent radial forces were approximately 30-40% higher than those crimped at room temperature. Coefficients of friction leveled to approximately 0.10 ± 0.01 as stent wire diameter increased and annulus size decreased from 23 to 19 mm. Regardless of aortic annulus size and species tested, it appeared that a minimum of about 2.5 mm in annular dilatation, caused by about 60 N of radial force from stent expansion, was needed to anchor the stent against a pullout into the left ventricle. The study of the contact biomechanics in animal aortic tissues may help us better understand characteristics of tissue-stent interactions and quantify the baseline responses of non-calcified aortic tissues.
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Affiliation(s)
- Joseph Mummert
- Tissue Mechanics Lab, Biomedical Engineering Program and Mechanical Engineering Department, University of Connecticut, 207 Bronwell Building, Storrs, CT 06269-3139, USA
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Treede H, Mohr FW, Baldus S, Rastan A, Ensminger S, Arnold M, Kempfert J, Figulla HR. Transapical transcatheter aortic valve implantation using the JenaValve system: acute and 30-day results of the multicentre CE-mark study. Eur J Cardiothorac Surg 2012; 41:e131-8. [DOI: 10.1093/ejcts/ezs129] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tamburino C, Barbanti M, Capodanno D, Ussia GP. Transcatheter aortic valve implantation: what has been done and what is going to be done. Future Cardiol 2010; 6:83-95. [DOI: 10.2217/fca.09.53] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Transcatheter valve implantation is developing into an effective and reproducible therapy for aortic valve stenosis. The origin of this technique was pursued in 1992 when Andersen demonstrated the feasibility of percutaneous implantation of catheter-based valve prosthesis. Since then a lot of technical and device advances have been made and to date, transcatheter aortic valve implantation has became a concrete alternative to surgical replacement. This paper aims to go over all the current devices, from the most widely used to the newest technology, focusing on device description, procedural issues, potential complications and clinical studies currently available in literature.
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Affiliation(s)
- Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy and ETNA Foundation, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy and ETNA Foundation, Catania, Italy
| | - Gian Paolo Ussia
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy and ETNA Foundation, Catania, Italy
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Bombien R, Lesche C, Lozonschi L, Feucker M, Brinkmann R, Dahmen C, Schünke M, Cremer J, Lutter G. Percutaneous Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010. [DOI: 10.1177/155698451000500112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- René Bombien
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claudia Lesche
- Institute of Micro-technology, University of Braunschweig, Braunschweig, Germany
| | - Lucian Lozonschi
- Division of Cardiothoracic Surgery, University of Wisconsin, Madison, WI USA
| | - Max Feucker
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ralf Brinkmann
- Institute for Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Christian Dahmen
- Division Microrobotics and Control Engineering, University of Oldenburg, Oldenburg, Germany
| | - Michael Schünke
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Percutaneous aortic valve replacement: emerging tractability for sufficient intracardiac resection of the aortic valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010; 5:55-9. [PMID: 22437277 DOI: 10.1097/imi.0b013e3181ceed96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : The feasibility of endovascular resection of highly calcified aortic valves has already been demonstrated by our group. Different endovascular and intracardiac tractability methods were applied. In this study, these technologies were analyzed comparing the tractability, the resection time, and the lesions in the surrounding tissue. METHODS : All aortic valve resections (seven human hearts and 21 porcine hearts) were performed using a Thulium:YAG laser (continuous wave, wavelength of 2.01 μm, 20 watts power rating). In the first resection system, the laser fiber was controlled by a free in-lying flexible endoscope (Ø 2.5 mm, length of 600 mm). The distal part of the endoscope (40 mm) was moved in one plane by proximal manual control (three degrees of freedom). The resection system was separated into defined rooms assigning one room for one tool. The fiber was controlled by the above-mentioned endoscope (*) (three degrees of freedom). The third resection system was a mechanical microactuator carrying the laser fiber (three degrees of freedom). The fourth resection system contains a rotatable inlay with defined rooms and a newly designed nitinol (NiTi) microactuator that controlled the laser fiber (four degrees of freedom). The resection time per leaflet was measured in minutes. Gross anatomy and histology in the surrounding tissue were evaluated. RESULTS : The resection time in approaches 1, 2, 3, and 4 was 5.5 ± 2.3 minutes, 7.4 ± 2.7 minutes, ± 6.6 minutes, and2.3 ± 1.2 minutes, respectively. The gross anatomy and histology of collateral damages revealed only superficial lesions of the surrounding tissue. The amount of lesions and the resection time were lower in the fourth approach with four degrees of freedom. CONCLUSIONS : This analysis demonstrated that a precise tractability with four degrees of freedom is necessary for a faster and safer endovascular resection of the aortic valve. The analysis will help to optimize the ongoing development of the endovascular and intracardiac resection technology.
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Lauten A, Figulla HR, Willich C, Laube A, Rademacher W, Schubert H, Bischoff S, Ferrari M. Percutaneous caval stent valve implantation: investigation of an interventional approach for treatment of tricuspid regurgitation. Eur Heart J 2009; 31:1274-81. [DOI: 10.1093/eurheartj/ehp474] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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