Valve Interventions in the Cardiac Catheterization Lab
In recent years, various techniques have been developed to treat heart valve disorders in the cardiac catheterization lab. Most of these treatments do not require surgery and general antesthesia, but may be performed with local anesthesia and light sedation. None of these techniques require cardio-pulmonary bypass.
At the University Hospital Heidelberg we have established a very active valvular program with many innovative treatments in the cardiac catheterization lab.
Transcatheter Aortic Valve Implantation (TAVI)
Transfemoral Aortic Valve Implantation
In patients with severe aortic stenosis, a surgical replacement of the aortic valve is considered as standard therapy. However, some patients have very high surgical risks, due to concomitant diseases or advanced age, and are thus not eligible for surgery.
These patients can be treated in the cardiac catheterization lab, receiving an aortic valve prosthesis via femoral artery (in the groin). This procedure only requires local anesthesia and light sedation. Neither surgery, nor cardipulmonary bypass is necessary. During this procedure, the narrow valve has to be dilated with a balloon (valvuloplasty). Then, the aortic valve prosthesis has to be placed in the diseased aortic valve position. Finally, the new prosthesis will be implanted either by balloon inflation (balloon mounted prosthesis- Edwards Sapien XT) or by retraction of an external sheath (self expanding prosthesis-CoreValve). At the University Hospital Heidelberg both systems are used to treat patients.
- Figure 1: Left-Aortic valve prosthesis that can be implanted via the femoral artery; the upper image shows an Edwards prosthesis that is implanted by balloon inflation; the lower image shows a CoreValve prosthesis that is self expanding. Right-images of implanted valves after contrast injection into the aorta.
Transapical Aortic Valve Implantation
Some patients who require an interventional aortic valve implantation have peripheral arteries that are too small for a transfemoral approach. In this case, a minimal-invasive transapical implantation ca be performed. In this procedure, access to the heart is achieved through the apex of the heart under general anesthesia. A catheter will be inserted into the beating heart and the narrow valve has to e dilated with a balloon (valvuloplasty). Then, the aortic valve prosthesis has to be placed in the diseased aortic valve position. Finally, the new prosthesis will be implanted by balloon inflation. This procedure is performed in a hybrid operation room with cardiac surgeons and cardiologists working together.
Special Aortic Valve Procedures
At the University Hospital Heidelberg several exceptional aortic valve procedures have been performed that do not belong to standard interventions. These include valve-in-valve implantations. Patients with prior surgically implanted aortic bioprosthesis may develop degenerations of the prosthesis over the years. A second surgical valve replacement may not be possible, due to advanced age and co-morbidities. In this case, a transfemoral implantation of a new prosthesis into the degenerated old prosthesis may be performed. We have successfully implanted several valves with this valve-in-valve technique.
Another exceptional procedure is the implantation of an aortic valve in patients with prior mitral valve replacement. Here again, we have successfully implanted several transfemoral and transapical aortic valves in such patients.
Implantation of a Mitral Valve Clip (MitraClip)
An insufficiency of the mitral valve (mitral valve regurgitation) is normally treated by surgical mitral valve replacement or repair. Some patients are considered as high risk patients for conventional surgery, especially when combined with severely decreased left ventricular function. An interventional technique in the cardiac catheterization lab can be used for a non-surgical treatment of this disease. A mitral valve clip (MitraClip) can be inserted into the left heart via the femoral vein (in the groin) and a puncture of the atrial septum. The clip can be advanced to the left ventricle and then be pulled back from the left ventricle into the left atrium, thus caching the mitral valve leaflets on the open clip arms The clip may then be closed, and therapeutic success will be immediately analyzed by ultrasound. This procedure requieres general anesthesia, but no surgery.
- Figure 2: A MitraClip has been fixed to both leaflets of the mitral valve, and is still attached to the delivery catheter (view from the left atrium)
- Figure 3: A MitraClip has been fixed to both leaflets of the mitral valve. The delivery catheter has been removed (lateral view).
Valvuloplasty
Some forms of valvular stenosis may be treated by balloon inflation (balloon valvuloplasty). This procedure may be performed with just some local anesthesia via femoral vein or artery (in the groin). The most common indication for a valvuloplasty is mitral valve stenosis. At the University Hospital Heidelberg we have experience in valvuloplasties of all four valves, including rare cases of stenosed bioprosthesis.
Team
Prof. Dr. Hugo A. Katus (Chair of the Department of Cardiology)
Prof. Dr. Raffi Bekeredjian (Attending, Head of the valvular program)
Dr. Emmanuel Chorianopoulos (Attending)
Dr. Ulrike Krumsdorf (Fellow)
Dr. Sven Pleger (Fellow)
Contact:
Aortic valve procedures: | Dr. Ulrike Krumsdorf (+49-6221-5638730) | |
Mitral valve procedures: | Dr. Sven Pleger (+49-6221-5638863) | |
Fax: +49-6221-565515 |
