title: Valve-in-a-valve concept for transcatheter minimally invasive repeat xenograft implantation.
abstract: OBJECTIVE
  This study sought to evaluate the feasibility of minimally invasive transapical repeat valve-in-a-valve (VinV) implantation.
  
  
  BACKGROUND
  Reoperative heart valve replacement for degenerated xenografts is associated with an increased surgical risk.
  
  
  METHODS
  Conventional Carpentier Edwards porcine aortic (n = 5) and mitral (n = 2) valve prostheses were implanted in 7 pigs. Transapical VinV implantation of a pericardial xenograft fixed within a 23-mm stainless steel, balloon expandable stent (Cribier Edwards, Edwards Lifesciences, Irvine, California) was then performed under fluoroscopic and echocardiographic visualization on the beating heart with ventricular unloading via cardiopulmonary bypass and rapid ventricular pacing.
  
  
  RESULTS
  Valve deployment was successfully performed in all cases. The radiopaque marking within the stent of the conventional aortic or mitral xenograft allowed for optimal positioning of the stent-delivered valve. All valves were firmly positioned without any migration. There were neither paravalvular nor transvalvular leaks, and good hemodynamic function was observed in all cases. All coronary arteries remained patent. Positioning and function were confirmed by autopsy in all animals.
  
  
  CONCLUSIONS
  The VinV concept is promising for minimally invasive beating heart repeat aortic or mitral valve replacement, using a stent-fixed sutureless prosthesis.
authors.affiliation: Klinik für Herzchirurgie, Leipzig, Germany. walt@medizin.uni-leipzig.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Todd
authors.initials: T
authors.lastname: Dewey
authors.forename: Jörg
authors.initials: J
authors.lastname: Kempfert
authors.forename: Fabian
authors.initials: F
authors.lastname: Emrich
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfannmüller
authors.forename: Petra
authors.initials: P
authors.lastname: Bröske
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000818:Animals; D001021:Aortic Valve / Q000601:surgery; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods; D004195:Disease Models, Animal; D005240:Feasibility Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016343:Monitoring, Intraoperative; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors; D012680:Sensitivity and Specificity; D034421:Sus scrofa; D014183:Transplantation, Heterologous