ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Ann Thorac Surg 2009;88:1864-1869. doi:10.1016/j.athoracsur.2009.08.004
© 2009 The Society of Thoracic Surgeons
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Elaine E. Tseng
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Google Scholar
Right arrow Articles by Azadani, A. N.
Right arrow Articles by Tseng, E. E.
PubMed
Right arrow Articles by Azadani, A. N.
Right arrow Articles by Tseng, E. E.
Related Collections
Right arrow Valve disease
Right arrowRelated Article

Original Articles: Adult Cardiac

Valve-in-Valve Implantation Using a Novel Supravalvular Transcatheter Aortic Valve: Proof of Concept

Ali N. Azadani, PhD, Nicolas Jaussaud, MD, Peter B. Matthews, BS, Liang Ge, PhD, T. Sloane Guy, MD, Timothy A.M. Chuter, MD, Elaine E. Tseng, MD*

Department of Surgery, University of California at San Francisco Medical Center and San Francisco Veterans Affairs Medical Center, San Francisco, California

Accepted for publication August 4, 2009.

* Address correspondence to Dr Tseng, Division of Cardiothoracic Surgery, UCSF Medical Center, 500 Parnassus Ave, Ste 405W, Box 0118, San Francisco, CA 94143-0118 (Email: elaine.tseng{at}ucsfmedctr.org).

Background: Transcatheter valve implantation within degenerated bioprostheses is a potentially promising treatment for high-risk surgical patients. Clinical experience is limited; however, we have shown in vitro that currently available transcatheter aortic valve sizes did not provide acceptable hemodynamics in small bioprostheses. The objective of this study was to develop a new transcatheter valve that would provide good hemodynamics within degenerated bioprostheses.

Methods: Supravalvular transcatheter valves were created using a Dacron covered stainless steel stent at the base and trileaflet pericardial leaflets in an open stent above the bioprosthesis. The transcatheter valves were implanted within 19-, 21-, and 23-mm Carpentier-Edwards Perimount bioprostheses with simulated degeneration using BioGlue to achieve a mean pressure gradient of 50 mm Hg. Hemodynamics of valve-in-valve implantation were studied in a pulse duplicator.

Results: Supravalvular transcatheter valves successfully relieved bioprosthetic stenosis. Acceptable hemodynamics were achieved with a significant reduction in mean pressure gradient of 54.0 ± 3.5 to 9.2 ± 6.3 mm Hg in 23-mm bioprostheses (p < 0.001), from 49.3 ± 3.1 to 14.4 ± 4.7 mmHg (p < 0.001) in 21 mm, and from 53.9 ± 3.8 to 28.3 ± 9.8 mm Hg (p = 0.013) in 19-mm bioprostheses. Effective orifice area after valve-in-valve implantation increased significantly and was comparable to rereplacement with the same size bioprosthesis.

Conclusions: Valve-in-valve implantation was performed using a novel supravalvular transcatheter valve, which successfully relieved bioprosthetic stenosis. The hemodynamics were comparable with standard surgical valve replacement. Further studies are required to assess device safety and efficacy in patients.


Related Article

Invited Commentary
Thomas Walther and Claudia Walther
Ann. Thorac. Surg. 2009 88: 1870. [Extract] [Full Text] [PDF]



This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
T. Walther and C. Walther
Invited commentary.
Ann. Thorac. Surg., December 1, 2009; 88(6): 1870 - 1870.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2009 by The Society of Thoracic Surgeons.