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

Alabama Medical Center First in Southeast to Offer CoreValve Evolut Pro TAVR Device
News | Heart Valve Technology| April 20, 2017
The Structural Heart Program at Princeton Baptist Medical Center, (Birmingham, Ala.) recently became the first center...
Updated AATS Guidelines Help Cardiovascular Surgeons Navigate Challenges of Managing Ischemic Mitral Regurgitation
News | Heart Valve Technology| April 20, 2017
April 20, 2017 — Mitral regurgitation can occur in up to 50 percent of patients with ischemic heart disease and even
PinnacleHealth Initiates Clinical Study of TriGuard Embolic Protection Device
News | Embolic Protection Devices| April 11, 2017
Through a new clinical trial, patients at Harrisburg, Pa.-based PinnacleHealth have access to an investigational device...
Boston Scientific is buying TAVI valve maker Symetis, which has European approval for its Acurate Neo valve

The Symetis Acurate Neo TAVI valve.

News | Heart Valve Technology| April 11, 2017
April 10, 2017 — Boston Scientific recently announced a $435 million cash deal to acquire Symetis SA, a privately-hel
heart-lung machine, ECMO, levosimendan, heart failure drug, cardiovascular surgery outcomes, ACC.17 study
News | Pharmaceuticals| March 28, 2017
When used as a preventive measure during heart surgery, the heart failure drug levosimendan did not significantly...
Sponsored Content | Videos | Heart Valve Technology| March 24, 2017
Michael Reardon, M.D., professor of cardiothoracic surgery at Houston Methodist DeBakey Heart and Vascular Center, di
microbleeds, brain bleeds caused by TAVR

An MRI brain scan showing multiple microbleeds in a transcatheter aortic valve replacement (TAVR) patient from the study.

Feature | Heart Valve Technology| March 23, 2017
March 22, 2017 — A quarter of the patients in a single-center study of 84 patients undergoing transcatheter aortic va
Cardiogard embolic protection system for surgical valve reaplacement

The CardioGard embolic protection system for surgical aortic valve replacement.

Feature | Embolic Protection Devices| March 22, 2017
March 22, 2017 — Two U.S.
Aegis Medical Innovations, Sierra Ligation System, U.S. clinical trial, FDA approval, LAA occluder
Technology | Left Atrial Appendage (LAA) Occluders| March 22, 2017
Aegis Medical Innovations Inc. announced that it has received Investigational Device Exemption approval from the U.S....
Overlay Init