| ObjectivesTo access the feasibility of off-pump transapical mitral valve-in-ring implantation and to test the performance of a custom-made self-expandable stent-valve.MethodsFive pigs underwent mitral valve annuloplasties under extracorporeal circulation and using26mm rings (SJMTM). Then, a30-mm custom-made self-expandable stent-valve first or a23-mm balloon-expandable transcatheter heart valve (Edwards SapienXTTM) was deployed within the annuloplasty rings through a transatrial access and under direct vision. In a second time, the stent-valve s were inserted transapically under fluoroscopic guidance and off-pump.ResultsThe procedural success of transatrial and transapical mitral valve-in-ring procedures was100%. Mean transatrial and transapical procedure time was2.0±1.1min and22.0±5.7min, respectively. Hemodynamic status during transapical implantation remained stable and differences in data collected before and after the stent-valve deployment were not statistically significant. Mean mitral annulus diameter and mean mitral orifice area in the group of self-expandable stent-valves were2.60±0.02cm and4.16±0.48cm2respectively, whereas in the Sapien group they were1.95±0.18cm and2.26±0.20cm, respectively. Trace or mild regurgitation was detected only in the self-expandable stent-valve group. Mean gradients were4.1±4.5mmHg across the self-expandable stent-valves and1.0±0mmHg across the Sapien valves. Postmortem examination confirmed adequate positioning of the self-expandable valves and the Sapien valves within the annuloplasty ring.ConclusionsTransapical mitral valve-in-ring implantation without bypass is safe and feasible. The transapical access can represent the ideal option in valve-in-ring procedures in case of recurrent mitral regurgitation after mitral valve repair, in high risk patients. Due to the supra-annular profile of the valve components, our custom-made nitinol stent-valve owns nearer to normal functional area than Sapien valve. |
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