Percutaneous valve replacement: significance of different delivery systems in vitro and in vivo

Percutaneous heart valve replacement is an exciting growing field in cardiovascular medicine yet still with some major problems. Only sophisticated improvement of the instruments could make it a real alternative to conventional surgery. Therefore, the aim of this study was to evaluate different deli...

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Bibliographic Details
Published in:Cardiovascular and interventional radiology 2006-06, Vol.29 (3), p.406-412
Main Authors: Attmann, Tim, Lutter, Georg, Quaden, René, Jahnke, Thomas, Rumberg, Kristin, Cremer, Jochen, Muller-Hulsbeck, Stefan
Format: Article
Language:English
Subjects:
Angiography
Animals
CARDIOVASCULAR DISEASES
Catheters
DRUGS
DUCTILITY
FATIGUE
Fluoroscopy
HEART
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - methods
IN VITRO
In Vitro Techniques
IN VIVO
Medical equipment
PERFORATION
Prosthesis Design
RADIOLOGY AND NUCLEAR MEDICINE
Sheep
Stents
SURGERY
Tomography, X-Ray Computed
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Summary:Percutaneous heart valve replacement is an exciting growing field in cardiovascular medicine yet still with some major problems. Only sophisticated improvement of the instruments could make it a real alternative to conventional surgery. Therefore, the aim of this study was to evaluate different delivery devices for percutaneous heart valve replacement in vitro and in vivo. A catheter prototype designed by our group, and two commercially available devices for the delivery of esophageal stents and aortic endoprostheses, were tested. After in vitro experiments, an ovine animal model of transfemoral pulmonary valve implantation was established using biological valved self-expanding stents. Only the delivery device for aortic endografts (Medtronic, Talent, Santa Rosa, CA, USA) allowed fast in vitro procedures without material fatigue. This device was chosen for the in vivo tests. Technical success was achieved in 9 of 10 animals (90%). One animal died after perforation of the ventricular wall. Orthotopic pulmonary placement was performed in 6 animals and intentional supravalvular valved stent placement in 3 animals. An adequate in vitro model for this evolving field of interventional heart valve replacement is presented. Furthermore, the present study pinpoints the key characteristics that are mandatory for a delivery system in percutaneous pulmonary valve implantation. With regard to the delivery device's ductility observed during this "venous" study, an approach to transfemoral aortic valve implantation seems feasible.
ISSN:0174-1551
1432-086X
DOI:10.1007/s00270-005-0244-4