Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Apr;16(4):482-7.
doi: 10.1093/icvts/ivs513. Epub 2013 Jan 9.

Early experiences and in-hospital results with a novel off-pump apico-aortic conduit

Oliver Reuthebuch  1 , Jens Fassl, John Brown, Martin Grapow, Friedrich Eckstein
Affiliations

Early experiences and in-hospital results with a novel off-pump apico-aortic conduit

Oliver Reuthebuch et al. Interact Cardiovasc Thorac Surg. 2013 Apr.

Abstract

Objectives: To offer surgical treatment in patients with aortic valve stenosis and contraindications for aortic valve replacement (e.g. ostial encroachment and previous mitral valve replacement). The aim of this study was to prove the feasibility and efficacy of this novel innovative off-pump apico-aortic conduit technique.

Methods: The bipartite conduit consists of an 18-mm prosthetic tube graft containing a stentless porcine aortic valve as well as a flexible semi-rigid and curved ventricular connector. Via left anterior lateral thoracotomy, the valved conduit is sutured to the descending aorta. The left ventricular connector is implanted with a gun-like applicator into the apex without cardiopulmonary bypass and with minimal blood loss.

Results: Between March and December 2011, 7 patients (5 females/2 males) with a mean age of 82 (79-89 years) were operated on. The mean logistic EuroSCORE I was 36.4 ± 23.7 (median 36.7%). The mean ejection fraction was 37 (25-65%) and the mean preoperative transaortic gradient was 38 (22-53 mmHg). Three patients had previous mechanical mitral valve replacement, 1 had a porcelain aorta and 3 had unfavourable distances between the aortic annulus and ostia (ostial encroachment). Implantation was uneventful in all patients, with need for limited cardiopulmonary bypass in only 1 patient. Postoperative mean transaortic gradient was 14 (11-25 mmHg). Approximately 70% of stroke volume was bypassed as measured in postoperative magnetic resonance. One patient died in hospital due to respiratory failure. New York Heart Association class in the other patients diminished from 3.6 to 1.6. No rhythmic disturbances or heart block were encountered.

Conclusions: With this novel conduit, we observed excellent haemodynamic results. We feel that this additional surgical approach to aortic stenosis in elderly, high-risk patients can augment conventional on-pump and interventional treatments of aortic stenosis.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
The aortic valve bypass kit consists of an angled left ventricular connector, a straight valved conduit and the gun-like applicator device to core and seal the apex as well as to implant the left ventricular connector (already mounted onto the device).
Figure 2:
Figure 2:
Coring of the apex with the applicator kit. The intraventricular balloon is inflated to achieve haemostasis. Sutures were passed through the sewing ring of the left ventricular connector. The valved conduit was already implanted.
Figure 3:
Figure 3:
Predischarge computed tomography scan showing the course of the apex to the descending aorta conduit.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. European Commission. Demography report 2010–older, more numerous and diverse Europeans. Eurostat 2011 [accessed 23 October 2012]. Available from: http://ec.europa.eu/social/BlobServlet?docId=6824&langId=en .
    1. Asimakopoulos G, Edwards MB, Taylor KM. Aortic valve replacement in patients 80 years of age and older: survival and cause of death based on 1100 cases: collective results from the UK Heart Valve Registry. Circulation. 1997;96:3403–8. - PubMed
    1. Varadarajan P, Kapoor N, Bansal RC, Pai RG. Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann Thorac Surg. 2006;82:2111–5. - PubMed
    1. Cribier A, Eltchaninoff H, Tron C. First human transcatheter implantation of an aortic prosthesis in a case of severe calcific aortic stenosis. Ann Cardiol Angiol (Paris) 2003;52:173–5. - PubMed
    1. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98. - PubMed

MeSH terms