Impact of the native aortic valve resection prior to percutaneous aortic valve implantation

(eng) Cardiac surgery is increasingly performed on elderly patients. This population has more co morbidities such as impaired ventricular function, coronary disease, peripheral vascular disease and renal insufficiency. These co morbid factors have been described as independent factors of mortality in this older population. Open heart surgery using cardiopulmonary bypass to replace the aortic valve is associated with a higher morbidity and mortality. Transcatheter Aortic Valve Implantation (TAVI) is a new approach to minimize the morbidity and mortality in selected high risk patients .In this technique, the calcified native valve remains in situ has to be squeezed between the transcatheter valve and the aortic wall. This leads to several problems: implantation of the valve into a non-circular calcified annulus with a risk of severe paravalvular leak , risk of coronary ostia occlusion, embolization of debris, increase the mitral insufficiency , too small effective aortic valve area. For this reason, resection of the native valve before implantation of the new valve makes sense for many surgeons who tried to develop an endovascular tool to remove the native valve. Several resection methods have been published using waterjet, laser cut or foldable cutting edges . In our study we describe a novel resection device designed for use in transapical and transaortic access. We also analyse the risk of cerebral embolisation during TAVI. We describe the development process and medical testing of the novel endovascular aortic valve resection device.