Transapical off-pump removal of the native aortic valve: A proof-of-concept animal study Stefano Salizzoni, MD, Pietro Bajona, MD, Kenton J. Zehr, MD,

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Presentation transcript:

Transapical off-pump removal of the native aortic valve: A proof-of-concept animal study Stefano Salizzoni, MD, Pietro Bajona, MD, Kenton J. Zehr, MD, William D. Anderson, MD, Stijn Vandenberghe, PhD, Giovanni Speziali, MD The Journal of Thoracic and Cardiovascular Surgery Volume 138, Issue 2, Pages 468-473 (August 2009) DOI: 10.1016/j.jtcvs.2009.03.057 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 The procedure for transapical removal of the aortic cusps. A, Insertion of the cutting device into the left ventricle through the apex. B, Capturing and cutting the cusp. C, Removing the cutting device and captured cusp from the left ventricle. This procedure was done for each cusp by simply rotating the cutting device 120° counterclockwise. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 468-473DOI: (10.1016/j.jtcvs.2009.03.057) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Echocardiographic monitoring of cusp removal and aortic regurgitation. A, Epicardial long-axis echocardiogram showing the cutting device (CD) inserted through the left ventricle (LV) grabbing the noncoronary cusp (NCC). The left main coronary artery (LCA) and left atrium (LA) are also visible. B, Massive aortic regurgitation (AR) immediately after the removal of the aortic valve. VP, Valve plane. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 468-473DOI: (10.1016/j.jtcvs.2009.03.057) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 The cutting device. Inner tube (1). Outer tube (2). The Journal of Thoracic and Cardiovascular Surgery 2009 138, 468-473DOI: (10.1016/j.jtcvs.2009.03.057) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 The assembled temporary valve. PU, Polyurethane; ePTFE, expanded polytetrafluoroethylene. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 468-473DOI: (10.1016/j.jtcvs.2009.03.057) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Electrical activity and hemodynamics after aortic cusp removal and temporary valve placement. Two-second recordings of electrical activity, arterial, atrial, and ventricular pressures, and coronary flow during the four experimental conditions tested. A representative experiment (pig 8) is shown. AP, Arterial pressure (plotted in black); LVP, left ventricular pressure (plotted in gray). LAP, left atrial pressure; CF, coronary flow. In the plots for CF, the horizontal gray lines represent zero. EKG, Electrocardiogram. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 468-473DOI: (10.1016/j.jtcvs.2009.03.057) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Behavior of the temporary valve in ascending aorta, A and B, Schematic design. C and D, Echocardiographic images. A and C, Temporary valve closed during systole to permit blood flow into the ascending aorta. B and D, Open in diastole to prevent aortic regurgitation. PU, Polyurethane leaflets; W, guidewire. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 468-473DOI: (10.1016/j.jtcvs.2009.03.057) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 The aortic root and cusps after the procedure. A, The aortic root at the end of the experiment. RCA, Right coronary artery ostium; LCA, left coronary artery ostium; NCC, cut noncoronary cusp; IVS, interventricular septum, which in pigs is thicker than in humans.23 B, Removed aortic cusps. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 468-473DOI: (10.1016/j.jtcvs.2009.03.057) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions