Transcatheter valve implantation: damage to the human aorta after valved stent delivery system exposure--an in vitro study.
Transcatheter heart valve implantation can be performed transapically and transfemorally. The transfemoral way to the aortic valve is significantly longer than the transapical one. The aim of this study was to analyse the intima of 15 human aortas after the deployment of different conventional valved stent delivery systems. Fifteen human aortas have been analysed (77 ± 8.4 years). These aortas were preserved with formalin and explanted from the common iliac arteries to the ascending aorta. After protocolling all relevant vascular parameters, the deployment force of different conventional valved stent delivery systems was analysed. After that, the intima was closely investigated by endoscopy. The deployment force of the old catheter was not different from the actual system. The endoscopic investigation revealed significant intimal damages in all parts of the aorta after deployment of the delivery system. This study demonstrated that the passage to the aortic valve can result in significant intimal damage regardless of the used deployment catheter. Efforts are necessary to lower the profile of the deployment devices to increase their flexibility. The intima of the aorta and possible damage have to get back into the physicians' focus to avoid possible late aortic complications.
Clinic of Cardiac Surgery,  University of Munich-Grosshadern, Munich,  Germany.
Paul Philipp
PP
Heinisch
Oliver
O
Richter
Michael
M
Schünke
Rene
R
Bombien Quaden
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002102:Cadaver; D006328:Cardiac Catheterization / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D006801:Humans; D008297:Male; D015607:Stents