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eComment. Sutureless aortic valve implantation in cases of calcified aortic annuli

Hannover Medical School, Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover, Germany

When operable patients become inoperable: conversion of a surgical aortic valve replacement into transcatheter aortic valve implantation

We read with great interest the case report by Olsen and co-workers describing the implantation of a percutaneous aortic valve in a patient with a severe calcified aortic annulus [1]. This bail-out procedure was performed using cardiopulmonary bypass (CPB) and cardioplegia, since severe calcification of the aortic annulus was finally detected after aortotomy. In the view of the authors, the situation in this case made a standard valve replacement impossible. Unfortunately, the authors did not report the aortic cross-clamp and CPB times, which were presumably prolonged.

In our institution, the feasibility of implantation of a sutureless aortic valve (Perceval Sorin) has been proven recently [2]. In a multicenter study, we could demonstrate good echocardiographic results using this new technique [3]. It appears especially useful in patients with severe calcification of the aortic root.

In comparison to the catheter-based aortic valve implantation techniques, our approach has the advantage of performing additional cardiac procedures (e.g. coronary artery bypass grafting), if necessary. Fast implantation of the device leads to reduced aortic cross-clamp times, particularly important in the cohort of so-called ‘high-risk patients’. In this context it has not to be mentioned that selection of patients for interventional techniques should not be performed using the EuroSCORE [4].

Nevertheless, we congratulate the authors for their approach, treating successfully this individual patient.

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1. Olsen LK, Arendrup H, Engstrom T, Sondergaard L. When operable patients become inoperable: conversion of a surgical aortic valve replacement in to transcatheter aortic valve implantation. Interact CardioVasc Thorac Surg 2009;9:837–839.[Abstract/Free Full Text]
2. Shrestha M, Khaladj N, Bara C, Hoeffler K, Hagl C, Haverich A. A staged approach towards interventional aortic valve implantation with a sutureless valve: initial human implants. Thorac Cardiovasc Surg 2009;56:398–400.[CrossRef]
3. Shrestha M, Folliguet T, Meuris B, Dibie A, Bara C, Herregods MC, Khaladj N, Hagl C, Flameng WJ, Laborde F, Haverich A. Sutureless perceval S aortic valve replacement: a multicenter, prospective, pilot trial. J Heart Valve Dis 2009. (in press).
4. Khaladj N, Shrestha M, Peterss S, Kutschka I, Strueber M, Hoy L, Haverich A, Hagl C. Isolated surgical aortic valve replacement after previous coronary artery bypass grafting with patent grafts: is this old-fashioned technique obsolete? Eur J Cardiothorac Surg 2009;35:260–264.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nawid Khaladj Christian Hagl Axel Haverich Malakh Shrestha Permission Requests Google Scholar Articles by Khaladj, N. Articles by Shrestha, M. PubMed PubMed Citation Articles by Khaladj, N. Articles by Shrestha, M. Related Collections Related Article