New Technologies

Resection of Calcified Aortic Heart Leaflets In Vitro by Q-Switched 2 µm Microsecond Laser Radiation

Corresponding Author

I. Rohde Dipl. Phys.

Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany

Address for correspondence: Ingo Rohde, Dipl.-Phys., Institute of Biomedical Optics, Peter-Monnik-Weg 4, D-23562 Lübeck, Germany. Fax : +49 (0)451/500 5965, e-mail: [email protected]

Search for more papers by this author

J.-M. Masch M.Sc,

J.-M. Masch M.Sc

Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany

Search for more papers by this author

D. Theisen-Kunde Dipl. Ing.,

D. Theisen-Kunde Dipl. Ing.

Medical Laser Center Lübeck, Lübeck, Germany

Search for more papers by this author

M. Marczynski-Bühlow Ph.D.,

M. Marczynski-Bühlow Ph.D.

Department for Cardiovascular Surgery, Campus Kiel, University Hospital of Schleswig-Holstein, Kiel, Germany

Search for more papers by this author

R. Bombien Quaden M.D.,

R. Bombien Quaden M.D.

Clinic of Cardiac Surgery, Campus Grosshadern, Ludwig Maximilian University, Munich, Germany

Search for more papers by this author

G. Lutter M.D.,

G. Lutter M.D.

Department for Cardiovascular Surgery, Campus Kiel, University Hospital of Schleswig-Holstein, Kiel, Germany

Search for more papers by this author

R. Brinkmann Ph.D.,

R. Brinkmann Ph.D.

Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany

Medical Laser Center Lübeck, Lübeck, Germany

Search for more papers by this author

I. Rohde Dipl. Phys.,

Corresponding Author

I. Rohde Dipl. Phys.

Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany

Address for correspondence: Ingo Rohde, Dipl.-Phys., Institute of Biomedical Optics, Peter-Monnik-Weg 4, D-23562 Lübeck, Germany. Fax : +49 (0)451/500 5965, e-mail: [email protected]

Search for more papers by this author

J.-M. Masch M.Sc,

J.-M. Masch M.Sc

Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany

Search for more papers by this author

D. Theisen-Kunde Dipl. Ing.,

D. Theisen-Kunde Dipl. Ing.

Medical Laser Center Lübeck, Lübeck, Germany

Search for more papers by this author

M. Marczynski-Bühlow Ph.D.,

M. Marczynski-Bühlow Ph.D.

Department for Cardiovascular Surgery, Campus Kiel, University Hospital of Schleswig-Holstein, Kiel, Germany

Search for more papers by this author

R. Bombien Quaden M.D.,

R. Bombien Quaden M.D.

Clinic of Cardiac Surgery, Campus Grosshadern, Ludwig Maximilian University, Munich, Germany

Search for more papers by this author

G. Lutter M.D.,

G. Lutter M.D.

Department for Cardiovascular Surgery, Campus Kiel, University Hospital of Schleswig-Holstein, Kiel, Germany

Search for more papers by this author

R. Brinkmann Ph.D.,

R. Brinkmann Ph.D.

Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany

Medical Laser Center Lübeck, Lübeck, Germany

Search for more papers by this author

First published: 21 December 2014

https://doi.org/10.1111/jocs.12481

Citations: 10

Conflict of interest: The authors acknowledge no conflict of interest in the submission.

Share a link

Email
Wechat
Bluesky

ABSTRACT

Background

Transcatheter aortic valve implantation (TAVI) can result in paravalvular leakage and stent deformation in the presence of severe calcification. This study was undertaken to determine the efficacy of laser-assisted resection of calcific aortic valve leaflets as a method to minimize the effects of calcium on perivalvular leakage during TAVI.

Methods

A Q-switched Tm:YAG laser emitting at a wavelength of 2.01 μm was used to evaluate the cutting efficiency on highly calcified human aortic leaflets in vitro (N = 10). A pulse energy of 4.3 mJ, a pulse duration of 0.8–1 μs, and a repetition rate of 1 kHz were used. The radiation was transmitted via a 200 µm core diameter quartz fiber. Resection was performed in a fiber-tissue contact mode on water-covered samples in a dish. The remnant particles were analyzed with respect to quantity and size by light microscopy.

Results

A resection rate of 40.4 ± 22.2 mg/min on highly calcified aortic leaflets was achieved. This corresponds to a cutting speed of approximately 1 cm/min; a laser dissection time of 3 min per leaflet is expected. The majority of the remnant particles (85.4%) were <6 μm in diameter, with only 0.1% exceeding 300 μm.

Conclusions

The Q-switched Tm:YAG laser system showed promising results in cutting calcified aortic valves, by transmitting sufficient energy through a small flexible fiber. Catheter-based removal of aortic valve calcification may help to improve TAVI technology. doi: 10.1111/jocs.12481 (J Card Surg 2015;30:157–162)

REFERENCES

1 Bleiziffer S, Ruge H, Mazzitelli D, et al: Results of percutaneous and transapical transcatheter aortic valve implantation performed by a surgical team. Eur J Cardiothorac Surg 2009; 35: 615–620.
10.1016/j.ejcts.2008.12.041
PubMed Web of Science® Google Scholar
2 Kempfert J, Rastan A, Holzhey D, et al: Transapical aortic valve implantation: Analysis of risk factors and learning experience in 299 patients. Circulation 2011; 11: S124–S129.
10.1161/CIRCULATIONAHA.110.013425
Web of Science® Google Scholar
3 Unbehaun A, Pasic M, Drews T, et al: Analysis of survival in 300 high-risk patients up to 2. 5 years after transapical aortic valve implantation. Ann Thorac Surg 2011; 92(4): 1315–1323.
10.1016/j.athoracsur.2011.05.077
PubMed Web of Science® Google Scholar
4 Vahanian A, Alfieri O, Al-Attar N, et al: In collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Transcatheter valve implantation for patients with aortic stenosis: A position statement from the European Association of Cardiothoracic Surgery (EACTS) and the European Society of Cardiology (ESC). EuroIntervention 2008; 4: 193–199.
10.4244/EIJV4I2A36
PubMed Google Scholar
5 Rodés-Cabau J: Transcatheter aortic valve implantation: Current and future approaches. J Nat Rev Cardiol 2012; 9: 15–29.
10.1038/nrcardio.2011.164
Web of Science® Google Scholar
6 Aallam B: Transfemorally or transapically deployed Sapien Edwards bioprosthesis is always deformed. J Intervent Cardiol 2012; 25(1): 53–61.
10.1111/j.1540-8183.2011.00679.x
PubMed Web of Science® Google Scholar
7 Arnold M, Schulz-Heise S, Achenbach, et al: Embolic cerebral insults after transapical aortic valve implantation detected by magnetic resonance imaging. EuroIntervention 2012; 1: 51–56.
Google Scholar
8 Rodés-Cabau J, Dumont E, Boone RH, et al: Cerebral embolism following transcatheter aortic valve implantation comparison of transfemoral and transapical approaches. J Am Coll Cardiol 2011; 1: 18–28.
10.1016/j.jacc.2010.07.036
Web of Science® Google Scholar
9 Quaden R, Leester-Schaedel M, Lozonschi L, et al: Transcatheter aortic valve replacement: Transapical resection of the aortic valve in vivo. Interact Cardiovasc Thorac Surg 2012; 15(3): 348–351.
10.1093/icvts/ivs246
PubMed Web of Science® Google Scholar
10 Lutter G, Kuklinski D, Berg G, et al: Percutaneous aortic valve replacement: An experimental study. I. Studies on implantation. J Thorac Cardiovasc Surg 2002; 123: 768–776.
10.1067/mtc.2002.121157
PubMed Web of Science® Google Scholar
11 Bombien R, Hümme T, Schünke M, et al: Percutaneous aortic valve replacement: Computer tomography scan after valved stent implantation in human cadaver hearts. Eur J Cardiothorac Surg 2009; 36: 592–594.
10.1016/j.ejcts.2009.04.068
PubMed Web of Science® Google Scholar
12 Zegdi R, Ciobotaru V, Noghin M, et al: Is it reasonable to treat all calcified stenotic aortic valves with a valved stent? Results from a human anatomic study in adults. J Am Coll Cardiol 2008; 51(5): 579–584.
10.1016/j.jacc.2007.10.023
PubMed Web of Science® Google Scholar
13 Zegdi R, Blanchard D, Achouh P, et al: Deployed Edwards Sapien prosthesis is always deformed. J Thorac Cardiovasc Surg 2010; 140(3): e54–e56.
10.1016/j.jtcvs.2010.03.003
PubMed Web of Science® Google Scholar
14 Webb JG, Chandavimol M, Thompson CR, et al: Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation 2006; 113: 842–850.
10.1161/CIRCULATIONAHA.105.582882
PubMed Web of Science® Google Scholar
15 Quaden R, Klaws GR, Theisen-Kunde D, et al: Percutaneous aortic valve replacement: First endovascular resection of human aortic valves in situ. Eur J Cardiothorac Surg 2007; 31(2): 305.
10.1016/j.ejcts.2006.10.039
PubMed Web of Science® Google Scholar
16 Theisen-Kunde D, Quaden R, Konrad A, et al: Resection of calcified aortic leaflets by 2 µm laser scalpel, Proceedings of Annual Congress of the German Society for Biomedical Engineering, Nürnberg, 2005;50:859-860.
Google Scholar
17 Quaden R, Attmann T, Boening A, et al: Percutaneous aortic valve replacement: Resection before implantation. Eur J Cardiothorac Surg 2005; 27: 836–840.
10.1016/j.ejcts.2005.01.048
PubMed Web of Science® Google Scholar
18 Bombien RH, Lozonschi L, Cremer J, et al: Transcatheter valve replacement: Resection and valved stent implantation in a beating heart. J Thorac Cardiovasc Surg 2010; 140: 477–479.
10.1016/j.jtcvs.2010.01.006
PubMed Web of Science® Google Scholar
19 Rohde I, Theisen-Kunde D, Brinkmann R: Temporally stretched Q-switched pulses in the 2 µm spectral range. Laser Phys Lett 2012; 9: 808–813.
10.7452/lapl.201210027
CAS Web of Science® Google Scholar
20 Brecht R, Friedrich M, Heinisch PP, et al: Transcatheter valve replacement: New concepts for microsurgery inside the heart. Innovations (Phila) 2013; 8(1): 29–36.
10.1097/IMI.0b013e31828440e8
PubMed Google Scholar

Citing Literature

All articles

Resection of Calcified Aortic Heart Leaflets In Vitro by Q-Switched 2 µm Microsecond Laser Radiation

ABSTRACT

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Resection of Calcified Aortic Heart Leaflets In Vitro by Q-Switched 2 µm Microsecond Laser Radiation

ABSTRACT

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Related

Information