Percutaneous aortic valve replacement: first endovascular resection of human aortic valves in situ☆

Endovascular resections of sclerotic aortic valves were undertaken in a human preparation. After deployment of the Aortic Valve Isolation Chamber via the descending aorta (Fig. 1 ), the surgeon resected the leaflets with an endoscopically guided laser scalpel via the right external carotid artery under endoscopic visualization (Fig. 2 , Video 1). A: An Aortic Valve Isolation Chamber (AVIC) system consists of an endoscope with two distal subvalvular balloons, one supravalvular balloon, an optic fibre and two different working channels (STI Endoskope, Henstedt-Ulzburg, Germany, O.K., W.R., Y.W., K.P., T.L.). B: Illustrated AVIC, positioned in the ascending aorta and the left ventricle of the heart (cross-view). Endoscopic views of the resection process. A: A sclerotic aortic valve and a guide wire. B: Deployment of AVIC via guide wire (supravalvular balloons in position). C: Grab catheter fixates the right coronary leaflet during laser resection (Tm:YAG laser, continuous wave, 2.01 μm wavelength, ITL 2000, Lisa Laser Products, Germany). Note: Inflated subvalvular balloon in background. In live humans coronaries will be secured with sealing cardioplegia cuff catheters. D: Nearly complete resected aortic valve. To avoid any lesion of the mitral valve, a wider margin of the acoronary leaflet was left. Supplementary data associated with this article can be found, in the online version, at 10.1016/j.ejcts.2006.10.039.