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You are here: Contents > 2012 > Volume 21 Number 4 July 2012 > AORTIC VALVE DISEASE > An Automated Coring and Apical Connector Insertion Device Facilitates Aortic Valve Bypass (Apicoaortic Conduit) Surgery: Preclinical Experience in a Chronic Ovine Model

An Automated Coring and Apical Connector Insertion Device Facilitates Aortic Valve Bypass (Apicoaortic Conduit) Surgery: Preclinical Experience in a Chronic Ovine Model

James S. Gammie, John W. Brown, J. Alan Crunkleton, Gregory J. Bittle1, Craig E. Stauffer, Anthony G. Liepert, Mehrdad Ghoreishi

Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, Division of Cardiac Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, Correx, Inc., Waltham, MA, USA

Background and aim of the study: Aortic valve bypass
(AVB, apicoaortic conduit) surgery is an alternative
treatment for high-risk patients with aortic stenosis
(AS). An automated coring and connector insertion
device designed to simplify the apical AVB
anastomosis has been developed. The applicator
consists of a toroidal shaft-mounted balloon, an
integrated circular coring knife, and a stented apical
connector supporting a Dacron graft. In this way,
apical myocardial coring, connector insertion and
core removal may be automated.
Methods: AVB was performed without
cardiopulmonary bypass in eight sheep. A conduit
containing a porcine valve was anastomosed to the
descending aorta using a partial occlusion clamp.
The applicator was used to insert the apical
connector, and the connector and conduit were
joined with a quick-connector. The descending aorta
was occluded proximal to the distal anastomosis to
simulate AS. Gradients across the conduit were

measured after implantation, and one month later
at sacrifice.
Results: All AVB implants were performed
successfully. The median blood loss was 50 ml (IQR:
13- 98 ml). The median connector implantation time
was 29 s, and the peak gradients across the conduit
early and at 30 days after AVB were 5.2 ± 2.6 mmHg
and 2.7 ± 1.4 mmHg, respectively. One animal died of
hemothorax at 24 h after surgery, but all remaining
animals survived and gained weight. Gross and
histopathologic assessments demonstrated widely
patent conduits and normal brain histology in
all animals.
Conclusion: The applicator facilitated the safe and
expeditious performance of AVB surgery. The
clinical use of this device will improve the safety and
increase the adoption of this beating-heart therapy
for AS.
The Journal of Heart Valve Disease 2012;21:494-501

An Automated Coring and Apical Connector Insertion Device Facilitates Aortic Valve Bypass (Apicoaortic Conduit) Surgery: Preclinical Experience in a Chronic Ovine Model

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