Akhyari, Payam

Bischoff, Sabine

Ferrari, Markus

Figulla, Hans

Laube, Adrian

Lauten, Alexander

Lichtenberg, Arthur

Schubert, Harald

Elsevier - Publisher Connector 

TCT-769 Functional Performance and Structural Maturation of Decellularised Pericardial Valves in Central Venous Position: An Experimental Study 

TCT-768
Noninvasive cardiac arrhythmia therapy using High-Intensity Focused
Ultrasound (HIFU) ablation
Qi Wu1, Qi Zhou2, Que Zhu2, Shunkang Rong3, Qi Wang4, Rui Guo2,
Changming Deng2, Dichuan Liu2, Gang Yang5, Yonghong Jiang2, Zhigang Wang2,
Han Lei6, Tong-Chuan He7, Zhibiao Wang8, jing huang9
1the Second Affiliated Hospital of Chongqing medical University, Chongqing,
Chongqing, 2the Second Affiliated Hospital of Chongqing Medical University,
Chongqing, Chongqing, 3the Second Affiliated Hospital of Chongqing Medical
University, Chongqing, chongqing, 4State Key Laboratory of Ultrasound
Engineering in Medicine Co-Founded by Chongqing and the Ministry, Chongqing,
Chongqing, 5the Second Affiliated Hospital of Chongqing Medical University,
Chongqing, Chongqig, 6the First Affiliated Hospital of Chongqing Medical
University, Chongqing, Chongqing, 7The University of Chicago Medical Center,
Chicago, IL, 8National Engineering Research Center of Ultrasound Medicine,
Chongqing, Chongqing, 9The second affiliated hospital of chongqing medical
university, Chongqing, Chongqing
Background: To investigate the feasibility and safety of transthoracic HIFU ablation for
blocking cardiac electrical conduction in a canine model.
Methods: Degreasing, degassing and establishment of artificial pleural effusion were
induced in 21 canines. We used HIFU to target the right side of the central fibrous body
guided by echocardiography. 10 canines received ablation only, 8 canines received
ablation and cardiac pacing for 2h, while 3 canines received ablation and cardiac pacing
for 3 months. At each endpoint, the targeted tissues were retrieved for gross, histological
and immunohistochemical evaluation.
Results: Complete atrioventricular block (AVB) was achieved in all 21 canines using
400W22.58.8s HIFU energy after acoustic coupling was improved. Recovery of AV
conduction was observed neither in the 8 canines with cardiac pacing for 2h, nor in the 3
canines which were maintained with cardiac pacing for 3 months. The ablation lesion had
a clear margin at the top part of interventricular septum with a necrosis of the conduction
fiber in all analyzed animals whereas small fibrosis of the target regions within intact
endothelium was found in the animals maintained for 3 months. No other complications
were observed except that mild hemorrhagic injury in the inferior lobe of left lung was
found in one animal.
Conclusions: Our findings indicate that the transthoracic HIFU for blocking cardiac
conduction is specific, safe and efficient, lending itself as a potentially novel approach for
arrhythmia therapy.
TCT-769
Functional Performance and Structural Maturation of Decellularised
Pericardial Valves in Central Venous Position: An Experimental Study
Alexander Lauten1, Adrian Laube1, Markus Ferrari1, Harald Schubert2,
Sabine Bischoff2, Arthur Lichtenberg3, Hans Figulla1, Payam Akhyari3
1University Heart Center Jena, Jena, Germany, 2Institute of Laboratory Animal
Science, Jena, Germany, 3Department of Cardiovascular Surgery, Duesseldorf,
Germany
Background: Patients with severe tricuspid regurgitation (TR) represent a therapeutic
challenge. Combining the excellent (pre-)clinical experience with decellularized heart
valves and the transcatheter valve implantation results, we sought to evaluated the
functional and structural outcome of decelluarised pericardial tissue valves(dTV) in the
venous circulation using a chronic animal model of TR.
Methods: 8 decellularized pericardial tissue valves were implanted in the inferior(IVC)
and superior(SVC) vena cava in a sheep model of severe TR. The devices were assembled
using self-expanding nitinol stents and bovine pericardia decellularized by an established
protocol (n8). Glutaraldehyde-fixed(GA) tissue served as control(GA-TV, n8). Prior
to implantation, severe TR was created by pulmonary banding and papillary muscle
avulsion. Valve implantation was performed by means of a 21F-catheter. After 6 month,
valve function and structural maturation were analysed by echocardiography, histology,
immunohistology and electron microscopy.
Results: Device was successful in all animals. After valve implantation, cardiac output
increased significantly from 4.4 l/min to 5.1 l/min (p0.05) and competent valve function
was verified by angiography. At 6 month, angiographic and echocardiographic evaluation
revealed moderate to severe regurgitation in all nTV. In contrast, 5 out of 8 dTV showed
excellent function with only minor regurgitation. In these animals autopsy revealed
preserved structural integrity of the valve with tender leaflets without signs of thrombosis
or calcification. In contrast, nTV leaflets showed severe valve degeneration with large
calcification areas. Microscopic and histologic analysis confirmed endothelial repopula-
tion of the leaflets in both valve types. However, in dTV additional interstitial reseeding
was noted.
Conclusions: In the venous low-pressure circulation, decellularized tissue valves show
superior functional performance compared to native pericardial tissue valves. Macro-
scopic and microscopic analysis suggests preserved structural integrity and advanced
endothelial and interstitial repopulation without evidence of degradation in decellularized
tissue valves.
PFO, ASD, and Congenital Heart Disease
Hall D
Tuesday, October 23, 2012, 8:00 AM–10:00 AM
Abstract nos: 770-778
TCT-770
Transcatheter Device Closure Of Atrial Septal Defect In Infants And Young
Children
Edwin Francis1, Raman Krishnakumar1, Shine Kumar1
1Amrita Institute of Medical Sciences, Cochin, Kerala
Background: Transcatheter closure of atrial septal defect (ASD) is the procedure of
choice for central fossa-ovalis defects. There is limited information on safety and
follow-up of transcatheter closure of ASD in young children. To describe our institutional
experience on transcatheter closure of atrial septal defect in infants and children weighing
10 kg.
Methods: Records of 56 patients weighing 10 kg (mean age: 28.70  9.54 months,
range 4 - 50 months; mean weight: 8.98  1.29 kg, range 4 - 10 Kg) who underwent
transcatheter closure of ASD in our Institute (January 2007- December 2011) were
reviewed.
Results: The study population represented 8.6 % of our total experience in this period.
Indications for closure included failure to thrive (75.1%), recurrent respiratory infections
(39.4%) and or heart failure (7.2 %). Case selection was through trans-thoracic
echocardiography. The ASD size was 14.66  3.27mm (range 9-23 mm) and mean
pulmonary artery pressure was 27  6.42 mm of Hg. Closure was achieved in all with
mean fluoroscopy time of 8.61  6.75 minutes; device size ranged from 9 to 24 mm.
General anesthesia and transesophageal echo guidance was utilized in 22 (39.3%). One
patient had embolisation of device immediately after release and was surgically retrieved.
Transient ECG abnormalities included first degree AV block (2) and junctional rhythm
(3). All had normal sinus rhythm at 24 hrs after procedure. On follow up (median 6
months; range 1-53 months) all were symptom free with over all improved weight z
scores (from -2.00  0.0 to -1.81  0.29; p  0.008), normal ECGs and satisfactory
device positions on echocardiograms.
Conclusions: The immediate and short-term follow up results of transcatheter device
closure of ASD are encouraging and suggest that the indications can be broadened to
include selected children  10 Kg.
TCT-771
Long-term results of a comparison of three patent foramen ovale closure
devices in a randomized trial (Amplatzer versus CardioSEAL-STARflex
versus Helex occluder)
Marius Hornung1, Jennifer Franke1, Stefan Bertog1, Margaret Taaffe1,
Laura Vaskelyte2, Undine Pittl3, Ilona Hofmann4, Horst Sievert5
1CardioVascular Center Frankfurt, Frankfurt am Main, Germany, 2CardiVascular
Center, Frankfurt, Germany, 3CardioVascular Center, Frankfurt, Germany,
4Cardiovascular Center, Frankfurt, Germany, 5CardioVascular Center Frankfurt,
Frankfurt, Germany
Background: Percutaneous patent foramen ovale (PFO)-closure for secondary stroke
prevention is discussed controversially, and long-term data comparing different closure
devices are very limited.
Methods: This is a prospective trial comparing procedural complications and long-term
results after PFO closure in 660 patients with cryptogenic stroke randomized to three
different closure devices: Amlpatzer (AGA Medical, Golden Valley, Minnesota), Helex
(W.L. Gore and Associates, Flagstaff, Arizona) and CardioSEAL-STARflex (NMT
Medical, Boston, Massachusetts), 220 patients per group). Patients were monitored for
recurrent cerebral ischemia (stroke, TIA or Amaurosis fugax), death and rate of complete
PFO closure during 5 year follow-up (including periprocedural events).
Results: We examined 660 patients (361 men, 299 women, mean age 49.3	/1.9
years). All PFO closures were successful technically. The procedure was complicated by
pericardial tamponade requiring surgery in 1 patient (Amplatzer device) and device
embolization in 3 patients (all Helex devices).
TUESDAY, OCTOBER 23, 8:00 AM–10:00 AM www.jacc.tctabstracts2012.com
B224 JACC Vol 60/17/Suppl B | October 22–26, 2012 | TCT Abstracts/POSTER/PFO, ASD, and Congenital Heart Disease
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TCT-769 Functional Performance and Structural Maturation of Decellularised Pericardial Valves in Central Venous Position: An Experimental Study

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