TITLE

Double-crowned valved stents for off-pump mitral valve replacement

AUTHOR(S)
Ma, Liang; Tozzi, Piergiorgio; Huber, Christoph H.; Taub, Steven; Gerelle, Gabrielle; von Segesser, Ludwig K.
PUB. DATE
August 2005
SOURCE
European Journal of Cardio-Thoracic Surgery;Aug2005, Vol. 28 Issue 2, p194
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Abstract: Objective: An animal model has been designed to assess the feasibility of off-pump mitral valve replacement using valved stents. Methods: Glutaraldehyde-preserved homograft was sutured inside a prosthetic tube (Dacron). Then, two self-expandable nitinol Z-stents were sutured on the external surface of the prosthesis in such a way to create two self-expanding crowns for fixation. In adult pigs and under general anesthesia, the left atrium was exposed through a left thoracotomy and atrio-ventricular roadmapping was performed with intravascular ultrasound (IVUS) and fluoroscopy. The double-crowned valved stents were loaded into a delivery sheath. The sheath was then introduced into the left atrium and the valved stents was deployed in mitral position in such a way that the part in between the two stents was at the level of the mitral annulus. Intracardiac Unltrasound (ICUS) was used to assess the valve function. Hemodynamic parameters were gathered as well. Animal survived for no more than 3h after the valve deployment and gross anatomy examination of the left heart was carried out. Results: The mean height of the valved stents was 29.4±0.2mm, with an internal diameter of 20.4±1.0mm, and an external diameter of 25.5±0.8mm. The procedure was successfully carried out in eight animals. In vivo evaluation showed a native mitral annulus diameter of 24.9±0.6mm, and a mean mitral valve area of 421.4±17.5mm2. ICUS showed a mild mitral regurgitation in three out of eight animals. Mean pressure gradient across the valved stents was 2.6±3.1mmHg. Mean pressure gradient across the left ventricular outflow tract (LVOT) was 6.6±5.2mmHg. The mean survival time was 97.5±56.3min (survival time range was 40–180min). One animal died due to the occlusion of the LVOT because of valved stents displacement. Postmortem evaluation confirmed correct positioning of the valved stent in the mitral position in seven out of eight animals. No atrial or ventricular lesions due to the valved stents were found. Conclusions: Off-pump implantation of a self-expandable valved stent in the mitral position is technically feasible. Further studies will assess if this procedure is also feasible in humans.
ACCESSION #
18157471

 

Related Articles

  • Comparison of intravascular ultrasonic imaging with versus without incomplete stent apposition at follow-up after drug-eluting stent implantation. Juying Qian; Feng Zhang; Hongyi Wu; Bing Fan; Lei Ge; Junbo Ge // International Journal of Cardiovascular Imaging;Feb2008, Vol. 24 Issue 2, p133 

    Abstract   Background Incomplete stent apposition (ISA) at follow-up has been reported to be more common after drug-eluting stent (DES) implantation than after bare-metal stent (BMS) implantation. The aim of this study was to use intravascular ultrasound (IVUS) to evaluate the...

  • Drug-Eluting Stents.  // Current Medical Literature: Interventional Cardiology Monitor;2005, Vol. 12 Issue 3, p77 

    Discusses abstracts of research papers about drug-eluting stents. "Early and mid-term results of drug-eluting stent implantation in unprotected left main," by A. Chieffo, et al; "Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies," by R. Moreno et al;...

  • Angiography-Guided Routine Coronary Stent Implantation Results in Suboptimal Dilatation. Johansson, Benny; Olsson, Hans; Wennerblom, Bertil // Angiology;Jan/Feb2002, Vol. 53 Issue 1, p69 

    Evaluates the need for intravascular ultrasound at routine angiography-guided high pressure stent implantation by comparing stent expansion with predefined intracoronary ultrasound criteria for optimal stent implantation. Percentage of optimal proximal stent entrance; Comparison between the...

  • New developments in intravascular ultrasound. Oshima, A.; Fitzgerald, P.; Itchhaporia, D. // Vascular Medicine;1998, Vol. 3 Issue 4, p281 

    Intravascular ultrasound (IVUS) is a dynamic imaging modality that provides real-time in vivo visualization of atherosclerosis and other vascular pathology. The tomographic image presentation of IVUS permits detailed assessment of plaque morphology and its corresponding responses to...

  • Angiographic and 3D intravascular ultrasound assessment of overlapping bare metal stent and three different formulations of drug-eluting stents in patients with diabetes mellitus. Ren Kawaguchi; Manel Sabate; Dominick Angiolillo; Pilar Jimenez-Quevedo; Nobuaki Suzuki; Cecilia Corros; Hideki Futamatsu; Fernando Alfonso; Rosana Hernandez-Antolin; Carlos Macaya; Theodore Bass; Marco Costa // International Journal of Cardiovascular Imaging;Feb2008, Vol. 24 Issue 2, p125 

    Abstract Objectives  The aim of this study was to examine the impact of overlapping bare-metal stent (BMS) and three different formulations of drug-eluting stent (DES) on intimal hyperplasia (IH) response of patients with diabetes mellitus (DM). ...

  • Minimally Invasive Mitral Valve Surgery: From Port Access to Fully Robotic-Assisted Surgery. Donias, Harry W.; Karamanoukian, Hratch L.; D'Ancona, Giuseppe; Hoover, Eddie L. // Angiology;Jan2003, Vol. 54 Issue 1, p93 

    Currently, there is a growing interest in minimally invasive cardiac surgery, and despite early criticisms, it has become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results. The interest in performing cardiac valve operations through...

  • Drug-Eluting Stents.  // Current Medical Literature: Interventional Cardiology Monitor;2006, Vol. 13 Issue 4, p112 

    The article presents comments on the findings of research on drug-eluting stents. They include "Pathology of Drug-Eluting Stents in Humans: Delayed Healing and Late Thrombotic Risk," by M. Joner, A. V. Finn et al, "Incomplete Neointimal Coverage of Sirolimus-Eluting Stents: Angioscopic...

  • The Role of Intravascular Ultrasound to Guide Drug-Eluting Stents Implantation. Nakamura, T.; Chen, J. P.; Panchal, D.; Nguyen, T.; King III, S. B.; Chronos, N.; Hou, D. // Cardiovascular & Hematological Agents in Medicinal Chemistry;2010, Vol. 8 Issue 1, p22 

    Serial IVUS has demonstrated significant differences in intimal hyperplasia (IH) volume between drug-eluting stent (DES) and bare metal stents (BMS) in recent clinical trials. It has also been reported that IVUS is a useful tool in determining optimal DES implantation, especially for diabetes...

  • Intravascular ultrasound of the transverse sinus in two patients with pseudotumor cerebri: technical note. Radvany, Martin G.; Gomez, Juan; Gailloud, Philippe // Journal of NeuroInterventional Surgery;Dec2011, Vol. 3 Issue 4, p379 

    Background The etiology of transverse sinus stenosis in patients with pseudotumor cerebri syndrome (PTCS) is unknown. The imaging findings of transverse sinus stenosis in two patients with PTCS using intravascular ultrasound (IVUS) before and after endovascular therapy with stent placement are...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics