Comparison of Different Resection Tools for Human Calcified Aortic Valves

Marczynski-Bühlow, M.; Gro, Justus; Berndt, Rouven; Röcken, Christoph; Wedel, Thilo; Böttner, Martina; Cremer, Jochen; Lutter, Georg; Petzina, Rainer

doi:10.1097/imi.0000000000000085

Cited by 2 publications

(1 citation statement)

References 20 publications

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“…To optimize the TAVI method and improve it to the level of a controlled surgical aortic valve replacement (sAVR), it is first necessary to remove the calcified or deformed valves before a subsequent implantation of the valved stent (14,15). The feasibility of several methods of transcatheter aortic valve resection has already been demonstrated by our group (16)(17)(18)(19).…”

Section: Original Articlementioning

confidence: 99%

Transcatheter aortic valve resection: new mechanical devices

Dai¹,

Lutter²,

Frank³

et al. 2020

J Thorac Dis

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Background: To improve periprocedural outcomes of transcatheter aortic valve implantation (TAVI), transcatheter mechanical resection devices were tested for prior ablation of the aortic cusps.Methods: Three mechanical transcatheter resection devices were tested in a series of native porcine (n=30) and reassembled calcified human valves (n=54). The resection time, the resected valve area, the number of released cusps, and the degree of surrounding tissue damage were measured. Afterwards, postmortem transapical-transcatheter-resections of the aortic valve in two humans were performed.Results: In the native porcine hearts, the Aesculap II device demonstrated significantly shorter resection time compared to the R&R II and the Randstad devices (6.5±2.0 vs. 28.6±24.1 vs. 23.3±14.4 sec; P=0.001).However, it created more lesions in the surrounding tissue (P=0.002). The R&R II achieved a smaller number of resected cusps than the other two devices (2.7±0.7 vs. 1.1±0.7 vs. 2.4±0.5; P<0.001, respectively).It also resected a smaller area of the aortic valve (306.5±149.2 vs. 106.7±29.6 vs. 256.8±81.3 mm2; P=0.09) but a larger mean area of the resected fragments (110.3±41.5 vs. 160.7±29.6 vs. 111.5±43.9 mm2; P=0.01).The resection of the reassembled human valves demonstrated the same results between the devices regarding resection time (P=0.001) and resected area (P=0.016), but not fragment sizes (P=0.610). Finally, transapical-transcatheter-resection of aortic valve was performed in two cadavers.Conclusions: Transcatheter aortic valve resection is feasible with variable aortic leaflet resection times and mild risk of lesions of the surrounding tissue.

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Section: Original Articlementioning

confidence: 99%

Transcatheter aortic valve resection: new mechanical devices

Dai¹,

Lutter²,

Frank³

et al. 2020

J Thorac Dis

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Development of a new catheter prototype for laser thrombolysis under guidance of optical coherence tomography (OCT): validation of feasibility and efficacy in a preclinical model

Berndt¹,

Rusch²,

Hummitzsch³

et al. 2017

J Thromb Thrombolysis

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In this feasibility study, a novel catheter prototype for laser thrombolysis under the guidance of optical coherence tomography (OCT) was designed and evaluated in a preclinical model. Human arteries and veins were integrated into a physiological flow model and occluded with thrombi made from the Chandler Loop. There were four experimental groups: placebo, 20 mg alteplase, laser, 20 mg alteplase + laser. The extent of thrombolysis was analyzed by weighing, OCT imaging and relative thrombus size. In the alteplase group, thrombus size decreased to 0.250 ± 0.036 g (p < 0.0001) and 14.495 ± 0.526 mm (p < 0.0001) at 60 min. The relative thrombus size decreased to 73.6 ± 4.1% at 60 min (p < 0.0001). In the laser group, thrombus size decreased significantly to 0.145 ± 0.028 g (p < 0.0001) and 11.559 ± 1.034 mm (p < 0.0001). In the alteplase + laser group, thrombus size decreased significantly (0.051 ± 0.026 g; p < 0.0001; 9.622 ± 0.582 mm; p < 0.0001; 47.4 ± 6.1%; p < 0.0001) in contrast to sole alteplase and laser application. The reproducibility and accuracy of the OCT imaging was high (SD <10%). Histological examination showed no relevant destruction of the vascular layers after laser ablation (arteries: 745.8 ± 5.5 μm; p = 0.69; veins: 448.3 ± 4.5 μm; p = 0.27). Thus, laser ablation and OCT imaging are feasible with the novel catheter and thrombolysis combining alteplase with laser irradiation appears highly efficient.

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Comparison of Different Resection Tools for Human Calcified Aortic Valves

Cited by 2 publications

References 20 publications

Transcatheter aortic valve resection: new mechanical devices

Transcatheter aortic valve resection: new mechanical devices

Development of a new catheter prototype for laser thrombolysis under guidance of optical coherence tomography (OCT): validation of feasibility and efficacy in a preclinical model

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