An automated coring and apical connector insertion device facilitates aortic valve bypass (apicoaortic conduit) surgery: Preclinical experience in a chronic ovine model

James S. Gammie, John W. Brown, J. Alan Crunkleton, Gregory J. Bittle, Craig E. Stauffer, Anthony G. Liepert, Mehrdad Ghoreishi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and aim of the study: Aortic valve bypass (AVB, apicoaortic conduit) surgery is an alternative treatment for high-risk patients with aortic stenosis (AS). An automated coring and connector insertion device designed to simplify the apical AVB anastomosis has been developed. The applicator consists of a toroidal shaft-mounted balloon, an integrated circular coring knife, and a stented apical connector supporting a Dacron graft. In this way, apical myocardial coring, connector insertion and core removal may be automated. Methods: AVB was performed without cardiopulmonary bypass in eight sheep. A conduit containing a porcine valve was anastomosed to the descending aorta using a partial occlusion clamp. The applicator was used to insert the apical connector, and the connector and conduit were joined with a quick-connector. The descending aorta was occluded proximal to the distal anastomosis to simulate AS. Gradients across the conduit were measured after implantation, and one month later at sacrifice. Results: All AVB implants were performed successfully. The median blood loss was 50 ml (IQR: 13- 98 ml). The median connector implantation time was 29 s, and the peak gradients across the conduit early and at 30 days after AVB were 5.2 ± 2.6 mmHg and 2.7 ± 1.4 mmHg, respectively. One animal died of hemothorax at 24 h after surgery, but all remaining animals survived and gained weight. Gross and histopathologic assessments demonstrated widely patent conduits and normal brain histology in all animals. Conclusion: The applicator facilitated the safe and expeditious performance of AVB surgery. The clinical use of this device will improve the safety and increase the adoption of this beating-heart therapy for AS.

Original languageEnglish (US)
Pages (from-to)494-501
Number of pages8
JournalJournal of Heart Valve Disease
Volume21
Issue number4
StatePublished - Jul 1 2012

Fingerprint

Aortic Valve Stenosis
Aortic Valve
Sheep
Thoracic Aorta
Equipment and Supplies
Hemothorax
Polyethylene Terephthalates
Cardiopulmonary Bypass
Histology
Swine
Transplants
Safety
Weights and Measures
Brain
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

An automated coring and apical connector insertion device facilitates aortic valve bypass (apicoaortic conduit) surgery : Preclinical experience in a chronic ovine model. / Gammie, James S.; Brown, John W.; Crunkleton, J. Alan; Bittle, Gregory J.; Stauffer, Craig E.; Liepert, Anthony G.; Ghoreishi, Mehrdad.

In: Journal of Heart Valve Disease, Vol. 21, No. 4, 01.07.2012, p. 494-501.

Research output: Contribution to journalArticle

Gammie, James S. ; Brown, John W. ; Crunkleton, J. Alan ; Bittle, Gregory J. ; Stauffer, Craig E. ; Liepert, Anthony G. ; Ghoreishi, Mehrdad. / An automated coring and apical connector insertion device facilitates aortic valve bypass (apicoaortic conduit) surgery : Preclinical experience in a chronic ovine model. In: Journal of Heart Valve Disease. 2012 ; Vol. 21, No. 4. pp. 494-501.
@article{de9542a3ccaa40958d702e50e55acf5a,
title = "An automated coring and apical connector insertion device facilitates aortic valve bypass (apicoaortic conduit) surgery: Preclinical experience in a chronic ovine model",
abstract = "Background and aim of the study: Aortic valve bypass (AVB, apicoaortic conduit) surgery is an alternative treatment for high-risk patients with aortic stenosis (AS). An automated coring and connector insertion device designed to simplify the apical AVB anastomosis has been developed. The applicator consists of a toroidal shaft-mounted balloon, an integrated circular coring knife, and a stented apical connector supporting a Dacron graft. In this way, apical myocardial coring, connector insertion and core removal may be automated. Methods: AVB was performed without cardiopulmonary bypass in eight sheep. A conduit containing a porcine valve was anastomosed to the descending aorta using a partial occlusion clamp. The applicator was used to insert the apical connector, and the connector and conduit were joined with a quick-connector. The descending aorta was occluded proximal to the distal anastomosis to simulate AS. Gradients across the conduit were measured after implantation, and one month later at sacrifice. Results: All AVB implants were performed successfully. The median blood loss was 50 ml (IQR: 13- 98 ml). The median connector implantation time was 29 s, and the peak gradients across the conduit early and at 30 days after AVB were 5.2 ± 2.6 mmHg and 2.7 ± 1.4 mmHg, respectively. One animal died of hemothorax at 24 h after surgery, but all remaining animals survived and gained weight. Gross and histopathologic assessments demonstrated widely patent conduits and normal brain histology in all animals. Conclusion: The applicator facilitated the safe and expeditious performance of AVB surgery. The clinical use of this device will improve the safety and increase the adoption of this beating-heart therapy for AS.",
author = "Gammie, {James S.} and Brown, {John W.} and Crunkleton, {J. Alan} and Bittle, {Gregory J.} and Stauffer, {Craig E.} and Liepert, {Anthony G.} and Mehrdad Ghoreishi",
year = "2012",
month = "7",
day = "1",
language = "English (US)",
volume = "21",
pages = "494--501",
journal = "Journal of Heart Valve Disease",
issn = "0966-8519",
publisher = "ICR Publishers Ltd",
number = "4",

}

TY - JOUR

T1 - An automated coring and apical connector insertion device facilitates aortic valve bypass (apicoaortic conduit) surgery

T2 - Preclinical experience in a chronic ovine model

AU - Gammie, James S.

AU - Brown, John W.

AU - Crunkleton, J. Alan

AU - Bittle, Gregory J.

AU - Stauffer, Craig E.

AU - Liepert, Anthony G.

AU - Ghoreishi, Mehrdad

PY - 2012/7/1

Y1 - 2012/7/1

N2 - Background and aim of the study: Aortic valve bypass (AVB, apicoaortic conduit) surgery is an alternative treatment for high-risk patients with aortic stenosis (AS). An automated coring and connector insertion device designed to simplify the apical AVB anastomosis has been developed. The applicator consists of a toroidal shaft-mounted balloon, an integrated circular coring knife, and a stented apical connector supporting a Dacron graft. In this way, apical myocardial coring, connector insertion and core removal may be automated. Methods: AVB was performed without cardiopulmonary bypass in eight sheep. A conduit containing a porcine valve was anastomosed to the descending aorta using a partial occlusion clamp. The applicator was used to insert the apical connector, and the connector and conduit were joined with a quick-connector. The descending aorta was occluded proximal to the distal anastomosis to simulate AS. Gradients across the conduit were measured after implantation, and one month later at sacrifice. Results: All AVB implants were performed successfully. The median blood loss was 50 ml (IQR: 13- 98 ml). The median connector implantation time was 29 s, and the peak gradients across the conduit early and at 30 days after AVB were 5.2 ± 2.6 mmHg and 2.7 ± 1.4 mmHg, respectively. One animal died of hemothorax at 24 h after surgery, but all remaining animals survived and gained weight. Gross and histopathologic assessments demonstrated widely patent conduits and normal brain histology in all animals. Conclusion: The applicator facilitated the safe and expeditious performance of AVB surgery. The clinical use of this device will improve the safety and increase the adoption of this beating-heart therapy for AS.

AB - Background and aim of the study: Aortic valve bypass (AVB, apicoaortic conduit) surgery is an alternative treatment for high-risk patients with aortic stenosis (AS). An automated coring and connector insertion device designed to simplify the apical AVB anastomosis has been developed. The applicator consists of a toroidal shaft-mounted balloon, an integrated circular coring knife, and a stented apical connector supporting a Dacron graft. In this way, apical myocardial coring, connector insertion and core removal may be automated. Methods: AVB was performed without cardiopulmonary bypass in eight sheep. A conduit containing a porcine valve was anastomosed to the descending aorta using a partial occlusion clamp. The applicator was used to insert the apical connector, and the connector and conduit were joined with a quick-connector. The descending aorta was occluded proximal to the distal anastomosis to simulate AS. Gradients across the conduit were measured after implantation, and one month later at sacrifice. Results: All AVB implants were performed successfully. The median blood loss was 50 ml (IQR: 13- 98 ml). The median connector implantation time was 29 s, and the peak gradients across the conduit early and at 30 days after AVB were 5.2 ± 2.6 mmHg and 2.7 ± 1.4 mmHg, respectively. One animal died of hemothorax at 24 h after surgery, but all remaining animals survived and gained weight. Gross and histopathologic assessments demonstrated widely patent conduits and normal brain histology in all animals. Conclusion: The applicator facilitated the safe and expeditious performance of AVB surgery. The clinical use of this device will improve the safety and increase the adoption of this beating-heart therapy for AS.

UR - http://www.scopus.com/inward/record.url?scp=84867187501&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867187501&partnerID=8YFLogxK

M3 - Article

C2 - 22953677

AN - SCOPUS:84867187501

VL - 21

SP - 494

EP - 501

JO - Journal of Heart Valve Disease

JF - Journal of Heart Valve Disease

SN - 0966-8519

IS - 4

ER -