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Fetal trans-apical stent delivery into the pulmonary artery: prospects for prenatal heart-valve implantation

Weber, Benedikt ; Emmert, Maximilian Y. ; Behr, Luc ; Brokopp, Chad ; Frauenfelder, Thomas ; Kretschmar, Oliver ; Falk, Volkmar ; Hoerstrup, Simon P.

In: European Journal of Cardio-Thoracic Surgery, 2012, vol. 41, no. 2, p. 398-403

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    Titre
    • Fetal trans-apical stent delivery into the pulmonary artery: prospects for prenatal heart-valve implantation
    Auteur
    • Weber, Benedikt. Clinic for Cardiovascular Surgery and Department of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
    • Emmert, Maximilian Y.. Clinic for Cardiovascular Surgery and Department of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
    • Behr, Luc. IMM RECHERCHE, Institut Mutualiste Montsouris, Paris, France
    • Brokopp, Chad. Clinic for Cardiovascular Surgery and Department of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
    • Frauenfelder, Thomas. Department of Medical Radiology, Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
    • Kretschmar, Oliver. Department of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland
    • Falk, Volkmar. Clinic for Cardiovascular Surgery and Department of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
    • Hoerstrup, Simon P.. Clinic for Cardiovascular Surgery and Department of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • European Journal of Cardio-Thoracic Surgery, 2012, vol. 41, no. 2, p. 398-403. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:300502
    Summary
    OBJECTIVE The purpose of this study was to assess the technical feasibility of a fetal trans-apical stent delivery into the pulmonary artery using a novel hybrid-intervention technique as a possible route for prenatal minimally invasive heart-valve-implantation approaches. METHODS Pregnant Pre-Alp sheep between 122 and 128 days' gestation (n=3) underwent a midline laparotomy. The fetus was left in utero or partially externalized and its chest was opened via a left-sided minithoracotomy. The fetal heart was cannulated and a guide wire was introduced through the ductus arteriosus into the aorta. A 14-French delivery system was then mounted onto the guide wire and advanced to the landing zone in the pulmonary artery, where the stent was deployed. The position of the stent was confirmed using echocardiography, angiography as well as computed tomography. RESULTS The trans-apical implantation was successful in all animals. However, at necropsy in one animal, the stent was found to partly occlude one of the pulmonary valvular leaflets. Bleeding at the antero-apical incision occurred in all animals but could be managed without fetal demise. No fetal cardiopulmonary bypass was performed. In all animals, contrast angiography displayed normal perfusion of the pulmonary vasculature as well as the ductus arteriosus. CONCLUSIONS Our study demonstrates the principal technical feasibility of a prenatal stent delivery into the pulmonary artery using a novel trans-apical hybrid-intervention technique. This approach demonstrates the first step towards possible future minimally invasive prenatal heart-valve-implantation procedures