Transcatheter Aortic Valve Resection: New Mechanical Devices

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2020 Dec 7

PMID 33282360

Authors

Huangdong Dai

Georg Lutter

Derk Frank

Sandra Freitag-Wolf

Ayca Topal

Assad Haneya

Janarthanan Sathananthan

Thomas Puehler

Affiliations

Soon will be listed here.

Abstract

Background: To improve periprocedural outcomes of transcatheter aortic valve implantation (TAVI), transcatheter mechanical resection devices were tested for prior ablation of the aortic cusps.

Methods: Three mechanical transcatheter resection devices were tested in a series of native porcine (n=30) and reassembled calcified human valves (n=54). The resection time, the resected valve area, the number of released cusps, and the degree of surrounding tissue damage were measured. Afterwards, postmortem transapical-transcatheter-resections of the aortic valve in two humans were performed.

Results: In the native porcine hearts, the Aesculap II device demonstrated significantly shorter resection time compared to the R&R II and the Randstad devices (6.5±2.0 28.6±24.1 23.3±14.4 sec; P=0.001). However, it created more lesions in the surrounding tissue (P=0.002). The R&R II achieved a smaller number of resected cusps than the other two devices (2.7±0.7 1.1±0.7 2.4±0.5; P<0.001, respectively). It also resected a smaller area of the aortic valve (306.5±149.2 106.7±29.6 256.8±81.3 mm2; P=0.09) but a larger mean area of the resected fragments (110.3±41.5 160.7±29.6 111.5±43.9 mm2; P=0.01). The resection of the reassembled human valves demonstrated the same results between the devices regarding resection time (P=0.001) and resected area (P=0.016), but not fragment sizes (P=0.610). Finally, transapical-transcatheter-resection of aortic valve was performed in two cadavers.

Conclusions: Transcatheter aortic valve resection is feasible with variable aortic leaflet resection times and mild risk of lesions of the surrounding tissue.

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