Document Detail

Transapical off-pump removal of the native aortic valve: a proof-of-concept animal study.
MedLine Citation:
PMID:  19619797     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study evaluates the feasibility of off-pump native aortic valve removal in preparation for transapical aortic valve replacement. Off-pump aortic valve replacement is performed by balloon predilatation of the native valve followed by insertion of a stented prosthesis. In patients with calcified annuli and cusps, particulate embolization, suboptimal prosthesis sizing, and perivalvular leaks may occur. Therefore, native valve removal may improve outcomes after transapical aortic valve replacement. METHODS: The aortic cusps were sequentially removed from 10 pigs in an off-pump procedure. A temporary valve was inserted percutaneously into the ascending aorta to prevent aortic regurgitation. The electrocardiogram, coronary blood flow, and arterial, left atrial, and ventricular pressures were continuously monitored. RESULTS: Removal of the aortic cusps caused a drop in diastolic arterial pressure and its equalization with left ventricular diastolic pressure. Systolic pressure decreased by 13.5%. Left atrial pressure increased by 86.0%. Coronary blood flow decreased by 39.9% and its pattern changed from mostly diastolic to mostly systolic. Electrocardiographic signs of ischemia appeared almost immediately. Percutaneous insertion of a temporary valve in the ascending aorta increased diastolic pressure and caused a tendency toward echocardiographic normalization. CONCLUSIONS: Aortic valve removal in a healthy beating heart causes acute massive aortic regurgitation, hemodynamic instability, and the rapid onset of myocardial ischemia. Reduction of left ventricular volume overload, by placement of a temporary valve in the ascending aorta, mitigates myocardial distress, helps stabilize hemodynamic parameters, and may be a useful tool to allow surgical manipulations of the aortic valve and annulus during transapical aortic valve replacement procedures.
Stefano Salizzoni; Pietro Bajona; Kenton J Zehr; William D Anderson; Stijn Vandenberghe; Giovanni Speziali
Related Documents :
15975387 - Pericardial patch augmentation for reconstruction of incompetent bicuspid aortic valves.
16805917 - Is there a role of statins in the prevention of aortic biological prostheses degeneration.
20099037 - A case of iatrogenic aortic valve leaflet perforation after closure of a ventricular se...
16564697 - Right ventricular restoration during pulmonary valve implantation in adults with congen...
9205187 - Minimally invasive axillary-coronary artery bypass.
1263537 - A method of preventing air embolus in open-heart surgery.
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-05-31
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  138     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-21     Completed Date:  2009-07-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  468-73     Citation Subset:  AIM; IM    
Division of Cardiothoracic Surgery-Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Aortic Valve / surgery*
Atrial Function, Right
Blood Pressure
Cardiac Surgical Procedures / instrumentation,  methods
Cardiopulmonary Bypass
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Sus scrofa
Ventricular Pressure

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Skeletal myoblast sheet transplantation improves the diastolic function of a pressure-overloaded rig...
Next Document:  Gene expression analysis of endobronchial epithelial lining fluid in the evaluation of indeterminate...