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Transapical Tricuspid Valved-Stent Implantation: Hemodynamic Evaluation of an Acute Animal Study
Jan-Paul Gundlach, Saskia Pokorny, Martin Marczynski-Bühlow, Telse M. BÄhr, Katharina Huenges, Huangdong Dai, Kenji Iino, Georg Lutter.
Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Kiel, Germany.
OBJECTIVE:
Off-pump minimally invasive tricuspid valve replacement could be favorable in selected patients. Aim of this study was to evaluate the functionality and hemodynamic parameters after implantation of a self-expanding valved stent in orthotopic position using a right transventricular approach through a ministernotomy.
METHODS:
The novel nitinol stent was composed of a right atrial cuff and a ventricular tubular body containing a bioprosthetic heart valve. The stent was covered with a polytetrafluoroethylene membrane, and a sealing-pouch was attached to the body, that was filled with a super-absorbent polymer (SAP). Eight pigs underwent off-pump tricuspid valved stent implantation through a transapical approach under transesophageal echocardiographic (TEE) guidance. Hemodynamic parameters were evaluated before implantation and 1h, 3h and 6h after implantation using a Swan-Ganz catheter. Gross examination of the heart was performed after euthanasia.
RESULTS:
Six of eight pigs were successfully implanted, showed normal hemodynamics after tricuspid valved-stent implantation and maintained stability during the 6h observation period (Table 1). Two pigs died due to ventricular fibrillation during stent deployment. Gross examination showed good positioning of the stent above the native annulus in all pigs. However, the stent was forced into an anatomical oval shape in 4 out of 6 cases. In all cases good paravalvular sealing due to the SAP pouch was observed.
CONCLUSIONS:
This acute study demonstrates normal and stable hemodynamics, resulting from good stent positioning and normal pressure values after off-pump transventricular tricuspid valved-stent implantation. However, an oval deformation of a significant number of stents was detected due to the anatomy of the native tricuspid annulus.
| Before implantation | 1h post implantation | 3h post implantation | 6h post implantation | |||||
| HR (1/min) | 65,5 | ± 14,2 | 111,3 | ± 24,0 | 104,8 | ± 21,3 | 109,3 | ± 23,6 |
| MAP (mmHg) | 65,7 | ± 9,8 | 56,5 | ± 13,7 | 51,8 | ± 16,1 | 58,0 | ± 12,0 |
| CVP mean (mmHg) | 7,2 | ± 1,8 | 8,7 | ± 3,7 | 7,7 | ± 2,4 | 8,0 | ± 1,8 |
| RVEDP (mmHg) | 5,0 | ± 3,1 | 3,4 | ± 2,2 | 2,8 | ± 2,0 | 3,0 | ± 2,3 |
| PAP mean (mmHg) | 15,2 | ± 2,3 | 15,2 | ± 2,4 | 14,7 | ± 4,8 | 13,2 | ± 4,1 |
| CO (l/min) | 3,7 | ± 0,7 | 4,5 | ± 0,4 | 3,6 | ± 1,1 | 3,7 | ± 1,0 |
| HR: heart rate, MAP: mean arterial pressure, CVP: central venous pressure, RVEDP: right ventricular enddiastolic pressure, PAP: pulmonary artery pressure, CO: cardiac output | ||||||||
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