Sutureless Stented Aortic Valve Implantation Under Direct Vision: Lessons From a Negative Experience in Sheep

Abstract

Sutureless implantation of a stented aortic valve through standard CPB and aortotomy is far more complex than expected. Changes in stent design and surgical approach are indicated.

First clinical experience and 1-year follow-up with the sutureless 3F-Enable aortic valve prosthesis☆☆☆

“…To our knowledge to date, only one animal study reports about implantations of a sutureless custom-made stented aortic valve. Although valve deployment took less than 1 min, the surgical procedure resulted in major complications in all cases: migration, paravalvular leakage, coronary ostia obstruction and mitral regurgitation [5,17]. In the present study, two patients were detected during follow-up with paravalvular leakage.…”

“…chronic obstructive pulmonary disease, poor left ventricular function, renal insufficiency or in the case of reoperation) open-heart surgery using cardiopulmonary bypass may be associated with an unacceptable morbidity and mortality [2,3]. To date, percutaneous aortic valve replacement either via transfemoral or transapical access is of inexorable progress and has even been suggested as an alternative to heart valve surgery in selected cases [4][5][6]. However, using these techniques, the calcified valvepathology remains in-situ and has to be dilated into the aortic wall prior to the implantation procedure.…”

“…However, using these techniques, the calcified valvepathology remains in-situ and has to be dilated into the aortic wall prior to the implantation procedure. As a result, the prosthesis may be implanted in an inhomogeneous and noncircular layer, leading to warping and geometry-changing of the prosthesis; paravalvular leakage/insufficiency may then remain a major concern [5,7,8].…”

Use of Circular Foldable Nitinol Blades for Resecting Calcified Aortic Heart Valves

“…These methods minimize concomitant trauma and can be used in beating-heart conditions: The native valve is pressed against the aortic wall via balloon valvuloplasty and represents the landing zone, where a stented biological prosthesis is implanted afterward. However, as this calcified layer may be non-circular, often paravalvular leakage and regurgitation can be observed; even distortion and geometry-change of the prosthesis and of the aortic annulus may result ( Ref 8,13,14). These factors may limit the function and long-term durability of the implanted valve.…”

In vitro results of a new minimally invasive aortic valve resecting tool☆☆☆

“…However, the calcified valve pathology remains in situ and has to be squeezed into the aortic wall by balloon valvuloplasty prior to the implantation procedure. As a result of this, the prosthesis may be implanted in an inhomogeneous and non-circular calcific layer, leading to distortion and geometry change of the prosthesis and of the aortic annulus, respectively [12][13][14]. Paravalvular leakage (PVL) and a high percentage of total heart block are of concern with a potential negative influence on longterm durability of the implanted prosthesis.…”