Feature | March 19, 2014

First Human Totally Endoscopic Aortic Valve Replacements (TEAVR) Reported

Surgeons Describe First TEAVR Procedures

March 19, 2014 — Surgeons in France have successfully replaced the aortic valve in two patients without opening the chest during surgery. The procedure, using totally endoscopic aortic valve replacement (TEAVR), shows potential for improving quality of life of heart patients by offering significantly reduced chest trauma. It is described in The Journal of Thoracic and Cardiovascular Surgery.

TEAVR had not been feasible previously because of the currently available designs of stented tissue valves. The recent advent of sutureless bioprostheses mounted on a compressible self-expanding nitinol (nickel titanium) stent, was one of the key factors enabling the surgical team to perform this procedure. Implantation required less than 45 minutes in either patient. Sutureless substitutes are not yet available for the other cardiac valves, like the mitral valve.

“In our institution, we began by adopting the mini-sternotomy technique, involving a small incision through the sternum, as routine. We then transitioned to the right mini-thoracotomy approach, involving a small incision through the thorax, first under direct view, then with an endoscopic camera. Finally we adopted a totally endoscopic technique,” said lead author Marco Vola, M.D., Ph.D, of the Department of Cardiovascular Surgery, Centre Hospitalier Universitaire de Saint-Etienne, France.

“It is important to note that when performing TEAVR, a quick and safe conversion to mini-thoracotomy under direct view can be made if circumstances demand. This would still offer significantly reduced chest trauma,” he said.

In other fields, totally endoscopic surgery involved longer clamping and cardiopulmonary bypass (CPB) times during the learning curve. The investigators believe that clamping and CPB times were acceptable and that the learning curve could be shorter than reported for totally endoscopic coronary artery bypass grafting.

Enhancements such as endoscopic sizers, dedicated instruments for decalcification, and second-generation sutureless bioprostheses to simplify implantation, could improve the procedure further, Vola and his colleagues comment. Last but not least, surgical robots may offer additional benefits.

“These first procedures show that totally endoscopic sutureless aortic valve replacement is technically feasible. Further clinical experience and technical development are necessary to shorten operation times and to assess further the potential postoperative benefits of TEAVR,” said Vola.

For more information: www.jtcvsonline.org

Related Content

Cardioband, valtech, Edwards Lifesciences, transcatheter mitral repair, transcatheter tricuspid valve repair, transcatheter annuloplasty

An illustration of how the transcatheter Cardioband System can used as a non-surgical form on annuloplasty repair. 

News | Heart Valve Technology| December 02, 2016
December 2, 2016 — Edwards Lifesciences Corp.
Mitralign, Trialign System, tricuspid regurgitation, first transcatheter repair, cardiac implantable device lead, Piedmont
News | Heart Valve Technology| November 18, 2016
Mitralign Inc. announced the successful compassionate use treatment of a patient suffering from tricuspid regurgitation...
Sponsored Content | Videos | TCT| November 18, 2016
DAIC Editor Dave Fornell takes a video tour of some of the most innovative new interventional cardiology technologies
Sponsored Content | Videos | Heart Valve Technology| November 18, 2016
A discussion with Juan Granada, M.D., about transcatheter mitral valve advancements and device challenges at the Tran
Sponsored Content | Videos | Heart Valve Technology| November 18, 2016
A discussion with Torsten Vahl, M.D., about advancements in transcatheter valve repair technology, including new devi
Greenbaum, Henry Ford Hospital, LAMPOON procedure, mitral valve
News | Heart Valve Technology| November 10, 2016
November 10, 2016 — A Henry Ford Hospital cardiologist is pioneering a promising new procedure to improve the success
NeoChord, RECHORD Trial, first patient, DS1000 System, degenerative mitral regurgitation, DMR
News | Heart Valve Technology| November 10, 2016
NeoChord Inc. announced the first use of its DS1000 System in the United States as it enrolled the first patient in the...
Sponsored Content | Videos | Heart Valve Technology| November 09, 2016
A discussion with Michael Reardon, M.D.
transcaval valve replacement, Henry Ford Hospital, Detroit Michigan, success rate, JACC study, TCT 2016
News | Heart Valve Technology| November 09, 2016
November 9, 2016 — A pioneering way to access the heart for...
transcatheter aortic valve replacement, pacemakers, implantation, post-TAVR implantation, worse outcomes, study
News | EP Lab| November 09, 2016
Patients who undergo minimally invasive heart valve replacement, known as transcatheter aortic valve replacement (TAVR...
Overlay Init