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Percutaneous aortic valve replacement: valvuloplasty studies in vitro
David Haberthür1, Georg Lutter, Marie Appel
1Institute for Anatomy, University of Bern, Bern, Switzerland.
Summary
Valvuloplasty for calcified aortic valves releases many calcific particles, posing a high risk of coronary artery embolism. Further research is needed to develop filtering techniques to mitigate this risk during valve procedures.
Area of Science:
- Cardiovascular Research
- Interventional Cardiology
- Biomaterials Science
Background:
- Aortic valvuloplasty is used for severe calcified aortic valve disease.
- Current methods have low clinical effectiveness and high complication rates.
Purpose of the Study:
- To analyze particle load after valvuloplasty.
- To assess embolization risk of calcific debris into coronary arteries using an in vitro model.
Main Methods:
- Sutured calcified human aortic leaflets into porcine annuli (N=9).
- Separated coronary arteries, cannulated, and drained into collection beakers.
- Performed valvuloplasty (Thyshak II, 20 mm, 1.5 atm), irrigated, filtered (0.45 μm), and analyzed particles microscopically.
Main Results:
- Median of 18 particles (>1mm) and 6574 particles (<1mm) found in coronary arteries post-valvuloplasty.
- Complete occlusion of coronary arteries occurred in 5 out of 9 cases.
- Significant particle load indicates high embolic potential.
Conclusions:
- Valvuloplasty on highly calcified aortic valves generates substantial calcific particles.
- High risk of coronary embolic events necessitates consideration during transcatheter valve implantation.
- Development of effective filtering techniques is crucial.
