Author + information
- Received June 17, 2012
- Accepted July 5, 2012
- Published online January 1, 2013.
- Alberto M. Leopaldi, MSc⁎,†,⁎ (, )
- Riccardo Vismara, PhD⁎,†,
- Guido Gelpi, MD†,‡,
- Claudia Romagnoni, MD†,
- Gianfranco B. Fiore, PhD⁎,†,
- Alberto Redaelli, PhD⁎,‡,
- Massimo Lemma, MD, PhD†,‡ and
- Carlo Antona, MD†,‡
- ↵⁎Reprint requests and correspondence
: Dr. Alberto Maria Leopaldi, Bioengineering Department, Politecnico di Milano, Via Golgi 39, 20133 Milan, Italy
The impact of the learning curve on the outcome of transcatheter aortic valve implantation (TAVI) is well recognized (1). A training platform that allows the operators to practice in the delivery and deployment maneuvers of the prosthesis could help to speed up the learning process and to develop a deeper awareness of TAVI-related issues.
We developed a simple, easily manageable, and cost-effective in vitro platform with a passive beating heart for both training and research purposes (2). The system houses an entire porcine heart and dynamically pressurizes the left ventricle with a pulse duplicator, thus replicating the physiological hemodynamic conditions. The platform allows the operator to perform transcatheter procedures under echo guidance and intracardiac endoscopy, so as to provide a straightforward cognition of the procedure.
The system was used to record: 1) a standard TAVI of a 29-mm CoreValve (Medtronic, Minneapolis, Minnesota); and 2) a valve-in-valve procedure of a 26-mm CoreValve implanted within a 23-mm Hancock II (Medtronic).
Online Videos 1 and 2 are available in the Online Data Supplement and show the TAVI and the valve-in-valve procedures in detail, with views from both the left ventricle and the aorta (representative snapshots are reported in Figs. 1 and 2).⇓⇓ The movies have a high educational relevance and allow immediate and accurate investigation of the transcatheter valve deployment steps and functioning. In particular, key factors, such as height of implant, valve positioning, size mismatch, and interactions with the surrounding structures (mitral–aortic junction, anterior mitral leaflet, and coronary ostia) can be evaluated.
Our system appears to be an ideal candidate as a widely spread platform for training purposes in the field of minimally invasive procedures.
For supplementary videos and their legends, please see the online version of this paper.
Supported by Fondazione per la Ricerca in Cardiochirurgia ONLUS. The Hancock II bioprosthesis, the CoreValve transcatheter prosthesis, and the delivery systems were all provided by Medtronic Inc. Dr. Lemma is a trainer and proctor for Edwards Lifesciences and for Medtronic in the field of minimally invasive surgery. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 17, 2012.
- Accepted July 5, 2012.
- American College of Cardiology Foundation