Thorac Cardiovasc Surg 2013; 61(05): 409-413
DOI: 10.1055/s-0032-1329270
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

DynaCT-Guided Anatomical Rotation of the SAPIEN XT Valve during Transapical Aortic Valve Implantation: Proof of Concept

Johannes M. Blumenstein
1   Department of Cardiac Surgery, Kerckhoff-Klinik, Heart Center, Bad Nauheim, Hessen, Germany
,
Arnaud Van Linden
1   Department of Cardiac Surgery, Kerckhoff-Klinik, Heart Center, Bad Nauheim, Hessen, Germany
,
Helge Moellmann
2   Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Hessen, Germany
,
Joerg Seeburger
3   Department of Cardiac Surgery, Herzzentrum, Universität Leipzig, Leipzig, Germany
,
Ardawan Rastan
4   Department of Cardiac Surgery, Herz und Kreislaufzentrum Rotenburg, Rotenburg a.d. Fulda, Germany
,
Won-Keung Kim
1   Department of Cardiac Surgery, Kerckhoff-Klinik, Heart Center, Bad Nauheim, Hessen, Germany
2   Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Hessen, Germany
,
Friedrich W. Mohr
3   Department of Cardiac Surgery, Herzzentrum, Universität Leipzig, Leipzig, Germany
,
Joerg Kempfert
1   Department of Cardiac Surgery, Kerckhoff-Klinik, Heart Center, Bad Nauheim, Hessen, Germany
,
Thomas Walther
1   Department of Cardiac Surgery, Kerckhoff-Klinik, Heart Center, Bad Nauheim, Hessen, Germany
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Weitere Informationen

Publikationsverlauf

16. Juni 2012

02. August 2012

Publikationsdatum:
17. Dezember 2012 (online)

Abstract

Background Transcatheter aortic valve implantation (T-AVI) by using the Edwards SAPIEN (Edwards Lifesciences LLC, Irvine, California, United States) prosthesis is currently being performed by the implantation of valved stent into the aortic annulus without respecting the native commissural (rotational) orientation. Anatomical orientation may, however, be beneficial regarding optimal physiological valve performance, optimal coronary flow, and avoidance of the fully covered commissural stent part in front of the coronary ostia. With the recently introduced SAPIEN XT, transcatheter valve identification of the commissures during fluoroscopy is feasible. The aim of this study was to evaluate the concept of Dynamic-CT (DynaCT)–guided anatomical rotation of the SAPIEN XT valve during transapical-AVI (TA-AVI).

Methods Intraoperatively, an automatically segmented DynaCT was performed using the Siemens Syngo Aortic ValveGuide (Siemens AG, Forchheim, Germany) software prototype. Commissures of SAPIEN XT could be identified with a high-quality fluoroscopic system. Before standard TA implantation, one radiopaque stent commissure of the crimped SAPIEN XT prosthesis was aligned with the native aortic valve commissure visualized by DynaCT. Resulting rotational orientation of the valve after implantation was assessed by transesophageal echocardiography.

Results Feasibility of anatomical rotation was evaluated in 10 patients scheduled for TA-AVI by an interdisciplinary heart team. Mean logistic EuroSCOREs and Society of Thoracic Surgeons scores were 23.7 ± 4.9% and 8.6 ± 2.1%, mean aortic gradient improved from 46.0 ± 21.9 to 9.6 ± 3.1 mm Hg, and there was no death within 30 days. All valves were implanted successfully with none or trivial paravalvular regurgitation in seven patients, mild (1 + ) in two patients, and moderate (2 + ) in one patient. An optimal anatomical position could be achieved in six patients, minor rotational deviation (< 10 degrees) in three patients, and moderate deviation (10 to 20 degrees) in one patient only.

Conclusions DynaCT-guided anatomical rotation of the SAPIEN XT valve is feasible during TA-AVI, avoiding implantation of the fully covered commissural posts in front of the coronary ostia. This might reduce the risk of coronary obstruction. In addition, the technique provides the potential benefit of physiological valve position and performance.

 
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