Circulation. 2002;105:775-778
doi: 10.1161/hc0602.103361
doi: 10.1161/hc0602.103361
(Circulation. 2002;105:775.)
© 2002 American Heart Association, Inc.
Basic Science Reports |
Steps Toward Percutaneous Aortic Valve Replacement
From the Service de Cardiologie Pédiatrique (Y.B.), Hôpital Necker Enfants Malades, Paris, France, and Cardiothoracic Unit (P.B.), Great Ormond Street Hospital, London, UK.
Correspondence to Dr Philipp Bonhoeffer, Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK. E-mail Bonhop{at}gosh.nhs.uk
Background— To date, the surgical approach is the only option to replace the aortic valve. Percutaneous pulmonary valve replacement has recently opened new perspectives on transcatheter replacement of cardiac valves. We report our experience of aortic valve replacement through a percutaneous technique in lambs.
Methods and Results— A bovine jugular vein containing a valve was dissected and sutured into a stent. Twelve lambs were divided into 3 groups. In the first, a valved stent was implanted in the descending aorta after creation of an aortic insufficiency. In the second, the valve was implanted in the native position. In the third, we inserted a valved stent in the native position using an orientation mechanism. All valves were successfully delivered and functioned perfectly in short-term evaluation. All experiments in group 2 failed: 1 valve obstructed the coronary artery orifices, 1 stent was responsible for a major mitral valve insufficiency, and the third implant migrated prematurely. A paraprosthetic leak occurred in the last animal in this group. Animals in group 3 had successful implantation of the valved stent. The orientation mechanism allowed perfect alignment of the device without any damage to the coronary circulation or to mitral valve function.
Conclusions— Nonsurgical implantation of an aortic valve is possible in lambs in the descending aorta and in the native position. An orientation mechanism is obviously needed to avoid obstruction of the coronary orifices. With further improvements, this technique should be feasible in humans.
Key Words: heart disease • aorta • valves
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