[Frontiers in Bioscience E2, 1368-1373, June 1, 2010]

Stent-based, off-pump creation of an apico-aortic conduit

Jan Spillner1, Nima Hatam1, Andrea Amerini1, Florian Otte1, Torsten Linde2, Gabriele Krombach3, Rudiger Autschbach1, Angelo Carpi4, Guido Dohmen1

1Clinic for Cardiothoracic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, D-52074 Aachen, Germany, 2 Applied Medical Engineering, Helmholtz Institute Aachen, Pauwelsstr. 20, D-52074 Aachen, Germany, 3 Clinic for Diagnostic Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, D-52074 Aachen, Germany, 4Department of Reproduction and Ageing, University of Pisa, Via Roma 67, 56126 Pisa, Italy

TABLE OF CONTENTS

1. Abstract
2. Introduction
3. Material and methods
3.1. Apical prosthesis
3.2. Coring sheath
3.3. Conduit prosthesis
3.4. Animal model
3.5. Operative procedure
3.6. Cardiac intervention
3.7. Further investigations
4. Results
4.1. Animals
4.2. Coring sheath
4.3. Apical prosthesis
4.4. Cardiac intervention
4.5. Further investigations/measurements
4.6. MRI
4.7. Postmortem examination
5. Discussion
6. Acknowledgment
7. References

1. ABSTRACT

An apico-aortic conduit (AAC) is an alternative therapy in patients with aortic valve stenosis and severe concomitant disease. We investigated whether it is feasible to create an apico-aortic conduit off-pump with a newly developed, stent-based coring- and cannulation-device in the animal model. A new self-expandable, stent equipped and hooked prosthesis and a sheath enabling both airtight removal of tissue and introduction of the prosthesis were designed and experimentally investigated in six pigs. Hemodynamic- and echocardiographic investigations were performed without and with aortic stenosis. In three animals MRI was performed. There was no significant blood loss, no relevant contamination with air and no hemodynamic depression during the whole procedure. It was possible to yield the entire cardiac output through the conduit after creating a high grade aortic stenosis. Autopsy revealed an excellent anchorage of the prosthesis. Neither relevant intracavitary injury nor thrombotic formation was seen. This study proves the feasibility of a stent-based, off-pump creation of an AAC. The principle of this approach might be used for other purposes.