title: Transcatheter mitral valve implantation: a percutaneous transapical system.
abstract: Despite recent achievements, implantation of a transcatheter mitral valved stent remains challenging. In this study, we present a different approach for implantation of a percutaneous mitral valved stent.
  
  
  
  Percutaneous transapical access is combined with, respectively, a left-transatrial, right-transatrial/transseptal or transfemoral/transseptal approach for mitral valve stent implantation and secure fixation. The apical fixation and occlusion are ensured with an Amplatzer occluder. This novel approach was tested in 22 porcine hearts in an in vitro setting under the guidance of fluoroscopy ( n  = 11) and endoscopy ( n  = 11). The in vitro setup included continuous flushing at 37 °C. We determined the feasibility, time of implantation, stent deployment and stent fixation.
  
  
  
  Percutaneous mitral valved stent implantation was successful in all cases. Good handling properties and precise positioning were achieved. Time of implantation was comparable in the fluoroscopic and endoscopic groups at 10:41 ± 3:18 and 10:09 ± 2:42 min, respectively. Apical fixation with the occluder was excellent in all 22 cases.
  
  
  
  The feasibility of percutaneous mitral valved stent implantation has been demonstrated in preliminary in vitro experiments. Subsequent studies are warranted to determine the efficacy of this minimally invasive catheter-based mitral valved stent implantation.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Huangdong
authors.initials: H
authors.lastname: Dai
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Huenges
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Saskia
authors.initials: S
authors.lastname: Pokorny
authors.affiliation: Department of Pediatric Cardiology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Gunther
authors.initials: G
authors.lastname: Fischer
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Cremer
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Metzner
authors.affiliation: Department Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany.
authors.forename: Derk
authors.initials: D
authors.lastname: Frank
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Lutter
mesh_terms: D000818:Animals; D005471:Fluoroscopy; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D008943:Mitral Valve; D009924:Organ Culture Techniques; D055989:Septal Occluder Device; D015607:Stents; D013552:Swine
keywords: Mitral valve; Off-pump; Percutaneous; Transcatheter