International Society For Minimally Invasive Cardiothoracic Surgery

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Redo Mitral Valve Surgery: Simplified Valve Re-replacement Using A Novel Leaflet Exchange System For Both Mechanical And Biological Prostheses.
Serghei Cebotari, Tobias Goecke, Anatol Ciubotaru, Christoph Bara, Klaus Hoeffler, Igor Tudorache, Axel Haverich.
Hannover Medical School, Hannover, Germany.

ObjectivesValve reoperations are often accompanied with an increased operative risk. Here we aimed to test in animal experiment the feasibility of “Easy Change” System developed for simple leaflets replacement for both mechanical and biological valves in redo valve surgery.MethodsThree mechanical and 3 biological Easy Change prostheses were used for mitral valve replacements in juvenile sheep. “Easy Change” Prostheses (MedEng) include 2 parts: permanent implanted ring and replaceable leaflets (mechanical or biological). During reoperations, implanted valves were replaced and after weaning from CPB, valves function was documented by echocardiography. Finally parts of the prostheses were histologically analyzed.ResultsAll animals survived the implantations. Four animals were successfully reoperated: 3 mechanical to biological (3, 6 and 9 months) and one biological to mechanical (6 months). Echocardiography showed excellent prostheses function prior and after re-replacement. Both mechanical and biological leaflets could be easily detached from the annulus and replaced by new prostheses. Re-replacement time was notably shorter then the previous implantation (19.7±4,0min vs. 59,3 ±6,1min). Two animals with biological valves died after 3 months: one due prosthetic endocarditis and one none-valve related. Valve re-replacement was performed ex vivo on explanted hearts. Histological analyses revealed tissue overgrowth of the ring, however it didn’t influence prostheses function and didn’t prevent the possibility of valve re-replacement. ConclusionThis animal study confirmed the feasibility of in vivo valve re-replacement, without having to remove the ring of the prosthesis. The compatibility of a permanently implanted part for both biological and mechanical leaflets represents a very promising technology for valvular surgery.

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