title: Comparison of different resection tools for human calcified aortic valves.
abstract: OBJECTIVE
  Symptomatic severe aortic valve stenosis is a disease primarily found in patients of advanced age. The standard therapy is the aortic valve replacement. Transcatheter aortic valve implantation (TAVI) is a treatment for patients ineligible for conventional aortic valve replacement. To minimize the incidence of TAVI-related complications, such as paravalvular leakage, pacemaker necessity, and ostial coronary occlusion, our research group works on the development of resection tools for aortic valves. The aim of this study was to investigate ex vivo different resection tools for human calcified aortic valves concerning cross-section morphology.
  
  
  METHODS
  With the use of 12 human calcified aortic leaflets, the effect of laser scalpel, punching device, and scissors on cross-section morphology was investigated. Scanning electron microscopy and histological analyses were applied to evaluate the cutting surface area.
  
  
  RESULTS
  The cross-section areas created by a laser scalpel were smooth, regular, and uniform, whereas these areas were rough, irregular, and inhomogeneous when using the scissors or the punching device. Quantitative analysis of the cutting edges demonstrated significant differences between the three resection tools. The best results were obtained for the laser scalpel compared with the punching device (P < 0.001) and for the laser scalpel compared with the scissors (P < 0.05), whereas the scissors compared with the punching device showed no significant differences (P > 0.05).
  
  
  CONCLUSIONS
  Laser cutting of human calcified aortic valves demonstrated the best results concerning homogeneous cross-section morphology compared with the punching device and the scissors and seems to be a promising tool for aortic valve resection during TAVI procedures in the future.
authors.affiliation: From the *Department of Cardiovascular Surgery; †Institute of Pathology, University Hospital Schleswig-Holstein, Campus Kiel; and ‡Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Marczynski-Bühlow
authors.forename: Justus
authors.initials: J
authors.lastname: Gro
authors.forename: Rouven
authors.initials: R
authors.lastname: Berndt
authors.forename: Christoph
authors.initials: C
authors.lastname: Röcken
authors.forename: Thilo
authors.initials: T
authors.lastname: Wedel
authors.forename: Martina
authors.initials: M
authors.lastname: Böttner
authors.forename: Jochen
authors.initials: J
authors.lastname: Cremer
authors.forename: Georg
authors.initials: G
authors.lastname: Lutter
authors.forename: Rainer
authors.initials: R
authors.lastname: Petzina
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D002114:Calcinosis / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans