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Comparison of Different Resection Tools for Human Calcified Aortic Valves

Marczynski-Bühlow, Martin PhD*; Gro, Justus MD; Berndt, Rouven MD*; Röcken, Christoph MD, PhD; Wedel, Thilo MD, PhD; Böttner, Martina MD, PhD; Cremer, Jochen MD, PhD*; Lutter, Georg MD, PhD*; Petzina, Rainer MD, PhD*

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: July/August 2014 - Volume 9 - Issue 4 - p 312–316
doi: 10.1097/IMI.0000000000000085
Original Articles

Objective Symptomatic severe aortic valve stenosis is a disease primarily found in patients of advanced age. The standard therapy is the aortic valve replacement. Transcatheter aortic valve implantation (TAVI) is a treatment for patients ineligible for conventional aortic valve replacement. To minimize the incidence of TAVI-related complications, such as paravalvular leakage, pacemaker necessity, and ostial coronary occlusion, our research group works on the development of resection tools for aortic valves. The aim of this study was to investigate ex vivo different resection tools for human calcified aortic valves concerning cross-section morphology.

Methods With the use of 12 human calcified aortic leaflets, the effect of laser scalpel, punching device, and scissors on cross-section morphology was investigated. Scanning electron microscopy and histological analyses were applied to evaluate the cutting surface area.

Results The cross-section areas created by a laser scalpel were smooth, regular, and uniform, whereas these areas were rough, irregular, and inhomogeneous when using the scissors or the punching device. Quantitative analysis of the cutting edges demonstrated significant differences between the three resection tools. The best results were obtained for the laser scalpel compared with the punching device (P < 0.001) and for the laser scalpel compared with the scissors (P < 0.05), whereas the scissors compared with the punching device showed no significant differences (P > 0.05).

Conclusions Laser cutting of human calcified aortic valves demonstrated the best results concerning homogeneous cross-section morphology compared with the punching device and the scissors and seems to be a promising tool for aortic valve resection during TAVI procedures in the future.

From the *Department of Cardiovascular Surgery; †Institute of Pathology, University Hospital Schleswig-Holstein, Campus Kiel; and ‡Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany.

Accepted for publication January 11, 2014.

Martin Marczynski-Bühlow and Justus Groß contributed equally to this study.

Supported by the Deutsche Forschungsgemeinschaft (LU 663/12-1), Bonn, Germany.

Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to Rainer Petzina, MD, PhD, Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany. E-mail:

©2014 by the International Society for Minimally Invasive Cardiothoracic Surgery