gms | German Medical Science

130. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

30.04. - 03.05.2013, München

Minimally Invasive Mitral Valved-Stent Implantation using an Off-Pump Technique

Meeting Abstract

  • Saskia Pokorny - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurige, Kiel
  • Katharina Huenges - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurige, Kiel
  • Telse Bähr - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurige, Kiel
  • Florian Bönke - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurige, Kiel
  • Holger Hettich - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurige, Kiel
  • Jochen Cremer - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurige, Kiel
  • Georg Lutter - Universitätsklinikum Schleswig-Holstein, Klinik für Herz- und Gefäßchirurige, Kiel

Deutsche Gesellschaft für Chirurgie. 130. Kongress der Deutschen Gesellschaft für Chirurgie. München, 30.04.-03.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13dgch617

doi: 10.3205/13dgch617, urn:nbn:de:0183-13dgch6178

Veröffentlicht: 26. April 2013

© 2013 Pokorny et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Off-pump implantation of a valved stent into the mitral position is in the focus of recent research. This innovative technique might allow the treatment of multi morbid patients suffering of severe mitral regurgitation, which are currently not compliant to open heart surgery and are hence denied surgery in many cases. This study presents a novel self-expanding valved stent designed for implantation into the mitral position in the beating heart.

Material and methods: The novel valved stent consists of an atrial element, a tubular ventricular body accommodating a bioprosthetic heart valve and a ventricular fixation system (Figure 1 [Fig. 1]). Eight pigs received a valved stent into the mitral position via transapical approach. Hemodynamic stability, stent function and positioning were assessed before (n=8), 1h after implantation (n=7) and one month (n=6) using transesophageal echocardiography (TEE). Cardiac computed tomography (CT) was performed after 10 days (n=6).

Results: One animal died of cardiac fibrillation during the implantation procedure and one animal died due to unrecognized inadequate valved stent positioning. Reliable stent stability and good positioning was achieved in the remaining six animals. TEE examination showed no significant mitral regurgitation and minimal gradients across the new valve and the LVOT. CT examination showed correct stent position, full stent expansion and minor deformation of the ventricular body. Large deformation of the stent geometry was observed at the junction between ventricular and atrial element in all cases. Gross evaluation of the six pigs demonstrated correct stent positioning, good ingrowths of the atrial element after one month (50%) and no thrombus formation (Figure 1 [Fig. 1]).

Conclusion: Reliable stent stability, minimal gradients and adequate stent function were seen throughout the study at a high degree of reproducibility, over a post-operative period of up to two months. The prospective focus will pertain to stent design, aiming at enhanced durability of the valved-stent components.