Percutaneous endoscopic transapical aortic valve implantation: three experimental transcatheter models

Interact Cardiovasc Thorac Surg. 2011 Sep;13(3):251-6. doi: 10.1510/icvts.2011.274852. Epub 2011 Jun 23.

Abstract

We sought to demonstrate the feasibility of an endoscopic approach to transapical aortic valve implantation (AVI), avoiding the morbidity of a thoracotomy incision. Using an experimental pig model, we performed three different approaches to transapical AVI, using a standard minithoracotomy (n=4), a robotic approach using the da Vinci telemanipulator (n=4) and an endoscopic approach using a port and camera access (n=4). The feasibility of the different techniques, exposure of the left ventricular apex, postoperative blood loss and total operative time were evaluated. Left ventricular apical exposure, 'purse-string' suture control and 33-F introducer access were successfully performed and confirmed videoscopically, fluoroscopically and at a post mortem in all 12 animals. The haemodynamics were stable in all animals. Mean intraoperative and postoperative (two-hour) blood losses were 88 and 65 ml with minithoracotomy, and 228 and 138 ml with the robotic and 130 and 43 ml with the endoscopic technique (P=0.26, P=0.14, respectively). There was no significant change in perioperative haematocrit (P=0.53). The mean total operative times were 1.4, 3.9 and 1.1 h (P=0.06), respectively. Percutaneous endoscopic and robotic transapical AVI are both feasible and can be performed in a timely manner with reasonable perioperative blood loss. Future research will focus on identifying optimal candidates for surgery based upon preoperative thoracic imaging.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Aortic Valve / surgery*
  • Blood Loss, Surgical / prevention & control
  • Cardiac Catheterization* / adverse effects
  • Feasibility Studies
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / methods*
  • Hematocrit
  • Hemodynamics
  • Models, Animal
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / prevention & control
  • Robotics
  • Sternotomy
  • Surgery, Computer-Assisted
  • Swine
  • Thoracic Surgery, Video-Assisted* / adverse effects
  • Thoracotomy
  • Time Factors