Abstract | OBJECTIVE: Balloon-expandable stent valves require flow reduction during implantation (rapid pacing). The present study was designed to compare a self-expanding stent valve with annular fixation versus a balloon-expandable stent valve. METHODS: Implantation of a new self-expanding stent valve with annular fixation (Symetis, Lausanne, Switzerland) was assessed versus balloon-expandable stent valve, in a modified Dynatek Dalta pulse duplicator (sealed port access to the ventricle for transapical route simulation), interfaced with a computer for digital readout, carrying a 25 mm porcine aortic valve. The cardiovascular simulator was programmed to mimic an elderly woman with aortic stenosis: 120/85 mmHg aortic pressure, 60 strokes/min (66.5 ml), 35% systole (2.8 l/min). RESULTS: A total of 450 cardiac cycles was analysed. Stepwise expansion of the self-expanding stent valve with annular fixation (balloon-expandable stent valve) resulted in systolic ventricular increase from 120 to 121 mmHg (126 to 830+/-76 mmHg)*, and left ventricular outflow obstruction with mean transvalvular gradient of 11+/-1.5 mmHg (366+/-202 mmHg)*, systolic aortic pressure dropped distal to the valve from 121 to 64.5+/-2 mmHg (123 to 55+/-30 mmHg) N.S., and output collapsed to 1.9+/-0.06 l/min (0.71+/-0.37 l/min* (before complete obstruction)). No valve migration occurred in either group. (*=p<0.05). CONCLUSIONS: Implantation of this new self-expanding stent valve with annular fixation has little impact on haemodynamics and has the potential for working heart implantation in vivo. Flow reduction (rapid pacing) is not necessary.
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Authors | Mathieu Vergnat, Roland Henaine, Martins Kalejs, Sandra Bommeli, Enrico Ferrari, Jean-Francois Obadia, Ludwig Karl Von Segesser |
Journal | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
(Eur J Cardiothorac Surg)
Vol. 35
Issue 6
Pg. 970-5; discussion 975-6
(Jun 2009)
ISSN: 1873-734X [Electronic] Germany |
PMID | 19409805
(Publication Type: Journal Article)
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Topics |
- Aortic Valve
(surgery)
- Blood Pressure
(physiology)
- Heart Valve Prosthesis
- Heart Valve Prosthesis Implantation
- Hemodynamics
(physiology)
- Humans
- Minimally Invasive Surgical Procedures
(methods)
- Models, Cardiovascular
- Prosthesis Design
- Stents
- Ventricular Pressure
(physiology)
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