[Transapical approach for aortic stented valve implantation: experimental results]. / Implantation transapicale d'une valve stentée aortique: résultats expérimentaux.

OBJECTIVE: Percutaneous aortic valve replacement has been performed in humans mainly for non-surgical candidates. We evaluated on animals a transapical approach to deliver an aortic stented valve without cardiopulmonary bypass. METHODS: A tubular pericardial valve fixed within a cobalt-nickel stent (Medtronic, Inc.) was implanted using a transapical approach in five adult sheep. A left thoracotomy was used to access the apex of the heart. The crimped valve was deployed in orthotopic position with a valvuloplasty balloon catheter on the beating heart after decreasing the left ventricular pressure by using either drugs or inferior vena cava occlusion. Deployments were performed under fluoroscopy and epicardial 2D Doppler echocardiography. Exact positioning of the valve into the target area was confirmed by autopsy at the end of the procedures. RESULTS: Valves were unsuccessfully deployed at the target site in all cases but one. Three valves were implanted in a supra-annular position with two of them in supracoronary position. One valve was implanted below the native annulus in the outflow tract. Valvular leak was noted in all but one implants. Coronary obstruction occurred twice and early valve retrograde migration once. Ventricular fibrillation or diastolic cardiac arrest occurred less than 20 minutes after stent deployment in all cases. CONCLUSION: In our experience the transapical approach does not facilitate delivery of a stented valve. Despite its technically feasibility, advanced stent design and improvements in delivery system are required before to continue experimental studies in transapical approach for aortic stented valve.

[The left ventricular reconstructive surgery at the origin of the treatment of cardiac insufficiency]. / La reconstruction ventriculaire a l'origine du traitement chirurgical de l'insuffisance cardiaque.

The surgical method of ventricular reconstruction described by Dor is recalled with the clinical report of a patient who presented a ventricular aneurysm. The left ventricular reconstructive surgery is based on an anatomical design of the heart described by Torrent-Guasp, where the normal orientation of the left ventricular muscle fibers, oblique in direction, is found parallel with the base of the heart at the time of ventricular dilation. By giving again an elliptic form to the left ventricle, the left ventricular reconstructive surgery improves the cardiac function of the patient who developed a bulky aneurysm after an infarction. Based on this concept, other techniques of ventricular reconstruction intended for patients presenting dilated cardiomyopathy, of ischemic origin or not, are being studied.

[Percutaneous cardiac valve replacement: a review]. / Remplacement percutané des valves sigmoïdiennes. Revue de la littérature.

Surgery is no longer the only technique to replace a cardiac valve. New percutaneous procedures allow aortic or pulmonary valve implantation. Even if the feasibility of these procedures has been proved, cases reported are very rare and selected. This emergent technology is still at an early stage of development and new prospective studies will be necessary to evaluate these procedures correctly before concluding their clinical benefit. At this time surgery remains the gold standard in terms of cardiac valve replacement.