Abstract 2536: Transapical Valve in a Valve Concept for Minimally Invasive Redo Xenograft Replacement
Objective: Aim of this study was to test the feasibility of minimally invasive transapical redo valve-in-a-valve (VinV) placement surgery as a treatment option for degenerated xenografts usually associated with an increased perioperative risk.
Methods: In 7 pigs the VinV concept was evaluated. On routine cardiopulmonary bypass (CPB) commercially available conventional Carpentier Edwards porcine aortic (n=5) and mitral (n=2) valve prostheses were implanted. The Ascendra™ valve replacement system, consisting of a pericardial xenograft fixed within a 23 mm stainless steel, balloon expandable stent (Edwards Lifesciences, Irvine, CA, USA) was then implanted using a subxiphoid minimally invasive incision and a transapical approach. Deployments were performed under fluoroscopic and echocardiographic visualization on the beating heart with ventricular unloading using CPB and rapid ventricular pacing.
Results: The transapical approach was relatively easy and safe in all experiments. Visualization was good and valve deployment successfully performed exactly at the target site in all cases. Alignment between the apically introduced delivery sheath and the target site was good. The radiopaque marking within the stent of the conventional aortic or mitral xenograft allowed for optimal positioning of the stent delivered valve. All valves were firmly positioned without any migration. There was neither para- nor transvalvular leak and good hemodynamic function. All coronary arteries remained patent. Exact positioning of the valve into the target area was confirmed by autopsy.
Conclusions: The VinV concept is promising for minimally invasive beating heart redo aortic or mitral valve replacement using a stent-fixed sutureless prosthesis.