title: Minimally invasive insertion of an equine stented pulmonary valve with a built-in sinus portion in a sheep model.
abstract: OBJECTIVE
  This study evaluated the feasibility of inserting a new equine stented-valve with a sinus portion in a lamb survival model, through a minimally invasive thoracotomy with right ventricular access without cardiopulmonary bypass.
  
  
  BACKGROUND
  Extant surgical or percutaneous methods for inserting biological valves in the right outflow tract have drawbacks and limitations.
  
  
  METHODS
  A decellularized equine valved jugular vein, sutured to a self-expanding stent with a sinus portion, was placed through a minimal right thoracotomy using a newly developed flexible hydraulic release device in seven lambs. The approach through the right ventricle into the pulmonary valve position is achieved on a beating heart.
  
  
  RESULTS
  The stented valves were correctly positioned in the right outflow tract, were competent up to 6 months as confirmed by angiography and echocardiography, and were well-tolerated by the animals, with endothelialization of the valve demonstrated at 6 months.
  
  
  CONCLUSIONS
  The newly developed hydraulic release system allowed for safe and reliable insertion of an equine stented-valve with a sinus portion, through a right transventricular approach on a beating heart, in a sheep survival model.
authors: Divison of Pediatric Cardiac Surgery, University Heart Center, Hamburg, Germany. a.dodge-khatami@uke.de
authors: Ali
authors: A
authors: Dodge-Khatami
authors: Stefan
authors: S
authors: Hallhagen
authors: Kuno
authors: K
authors: Limacher
authors: Björn
authors: B
authors: Söderberg
authors: Rolf
authors: R
authors: Jenni
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001705:Bioprosthesis; D005240:Feasibility Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006736:Horses; D007601:Jugular Veins / Q000637:transplantation*; D023421:Models, Animal; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D015641:Radiography, Interventional; D012756:Sheep; D015607:Stents; D013908:Thoracotomy; D013997:Time Factors; D014463:Ultrasonography