Images of Note: In Aortic Valve Replacement, Two Parts May Be Better than One

The following intraoperative images show essential steps in the implantation of a promising advance in aortic valve replacement: the advent of a two-part aortic bioprosthetic valve — namely, the ValveXchange Vitality™ aortic bioprosthesis.

This novel approach involves surgical placement of the valve’s base in the aortic root (first image above) followed by installation of a tri-leaflet set (three bovine pericardium tissue leaflets mounted on a circular frame) on top of the base (second image above). The two component parts of the bioprosthesis are depicted below.

Several objectives drove this two-part valve design, including:

• Greater visibility during implantation of the valve base, with no leaflets blocking the view
• The opportunity for smaller incisions, since the base is half the height of the ultimately assembled valve
• The ability to exchange the initial leaflet set with a new one during re-do valve replacement procedures

The latter objective of leaflet exchangeability becomes increasingly desirable as patients receive tissue valves at ever-younger ages and live increasingly long and active lives (see related post). In these cases, if a reoperation is eventually needed to replace a worn-out tissue valve, only the leaflet (not the base) needs to be replaced, which can be done less invasively and more quickly than full bioprosthetic replacement.

Cleveland Clinic surgeon and Heart & Vascular Institute Chair Lars G. Svensson, MD, PhD, implanted the first Vitality aortic bioprosthesis in a human in September 2011, and Cleveland Clinic continues to play a lead role in studying the device, which is approved for use in Europe but still investigational in the United States.