Percutaneous aortic valve replacement: gross anatomy and histological findings after transapical and endoluminal resection of human aortic valves in situ.
OBJECTIVE
Transluminal resection of the aortic valve was already successfully carried out by our group. The aim of this study was the analysis of the gross anatomy and the histology of the surrounding tissue after resection.


METHODS
Aortic valve resection was performed in postmortem human hearts (endoluminal (EL) n=9, transapical (TA) n=4). After deployment of the aortic valve isolation chamber, the leaflets were resected with a Thullium:YAG laser scalpel (cw, 20W). After resection, the hearts were analyzed to check for lesions caused by resectioning the associated tools. Therefore, gross anatomy and histological analysis were performed (H&E staining).


RESULTS
Lesions of the aortic annulus were seen in 3/9 (EL) (depth: 583+/-186 microm) and 2/4 (TA) (120 microm and one complete perforation), lesions of the aorta (ascending-arch-descending) in 4-9-0/9 (EL) and 0-0-0/4 (TA), lesions of the mitral valve in 0/9 (EL) and 0/4 (TA), lesions of the papillary muscle in 0/9 (EL) and 2/4 (TA) (depth: 400 microm and 450 microm), lesions of the endomyocardium in 0/9 (EL) and 4/4 (TA) (depth: 258+/-102 microm). The coronary ostia remained unaffected.


CONCLUSIONS
This study shows fewer severe lesions in the aorta after transapical antegrade access compared to the transluminal retrograde approach. Especially noteworthy is that the aortic arch remains unaffected by the transapical procedure. These data demonstrate the transapical approach as less hazardous.
Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
René Hubert
RH
Bombien
Marie
M
Appel
Tim
T
Attmann
Günter-Rudolf
GR
Klaws
Michael
M
Schünke
Christine
C
Hass
Jochen
J
Cremer
Georg
G
Lutter
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology; D001013:Aorta, Thoracic / Q000473:pathology; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000473:pathology; D050197:Atherosclerosis / Q000473:pathology; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods