Abstract
The aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such a risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation has been viable, with lower morbidity and mortality. The aim of this study was to develop a national catheter-mounted aortic bioprosthesis for the aortic position implant. After animal studies, 14 patients with high EuroSCORE underwent transcatheter aortic valve implantation. Median Logistic EuroSCORE was 43.7%. Four patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. All patients presented symptoms. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis was implanted through the ventricular apex under ventricular pacing or hemorrhagic shock, after aortic valvoplasty. Echocardiograph and angiograph controls were performed, and the patients were referred to ICU. Implant was feasible in 13 cases. There were no intra-operative deaths. Median peak transvalvular aortic gradient reduced to 25.0 mmHg, and left ventricular function improved in the first seven post-operative days. Paravalvular aortic regurgitation was mild and present in 71%. No definitive pacemaker was needed. There was no peripheral vascular complication. Overall mortality was 42%. The transapical implantation of cathetermounted bioprosthesis was a feasible procedure. Long term follow-up is mandatory in order to access efficacy and indications.
Highlights
The degenerative aortic valve calcification related to aging is the most common cause of aortic stenosis in developed countries
Using the development of aortic stent with national technology as a model, which allowed the general population to have a larger access to these restricted techniques, the Discipline of Cardiovascular Surgery, at the Federal University of São Paulo started to develop a project of an aortic valve prosthesis for transcatheter implantation in partnership with the private sector (Braile Biomedica, São José do Rio Preto) and the FAPESP - The São Paulo State Research Support Foundation, an State Agency the aim of providing grants, funds and programs to support research, education and innovation of private and public institutions and companies in the state of São Paulo
The differential this prosthesis is based on the fact that the structure of the pericardium can be made with no need of intermediate sutures, probably increasing the resistance to wear and tear of the material
Summary
The transapical implantation of cathetermounted bioprosthesis was a feasible procedure. Resumo Objetivo: A troca valvar aórtica é procedimento rotineiro com risco aceitável. O implante minimamente invasivo transcateter de valva aórtica parece ser uma alternativa, reduzindo a morbi-mortalidade. O objetivo deste estudo foi o desenvolvimento e implante de nova prótese transcateter. 1. Doctorate’s degree; MD, Cardiovascular Surgery discipline. 8. Full Professor, Cardiovascular Surgery Discipline – UNIFESP. Métodos: Após desenvolvimento em animais, uma prótese transcateter, balão-expansível foi utilizada em 14 casos de alto risco. Com o uso de minitoracotomia esquerda, as próteses foram implantadas através do ápice ventricular, sob estimulação ventricular de alta frequência ou choque hemorrágico controlado, após valvoplastia aórtica. Resultados: A correta liberação da prótese foi possível em 13 casos. Insuficiência aórtica residual não significativa esteve presente em 71% dos casos, nenhuma significativa. Conclusão: O implante transapical de valva aórtica transcateter é um procedimento possível com esta nova prótese.
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