nitinol and Aortic-Valve-Insufficiency

Topics: Aged; Aged, 80 and over; Alloys; Animals; Aortic Valve Insufficiency; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Prosthesis Design; Swine; Transplantation, Heterologous

Transcatheter aortic valve replacement has become a mainstay alternative to surgical aortic valve replacement in patients with severe aortic stenosis at high and intermediate surgical risk. Two commercially approved valves are available in the United States: balloon-expandable and self-expanding. We report here a rare complication of a self-expanding Evolut PRO (Medtronic, Minneapolis, Minnesota) valve failing to expand due to nitinol frame infolding. This results in a malopposed valve with a severe paravalvular leak, even though treated successfully with balloon valvuloplasty. It is important to recognize the characteristic angiographic signature of this complication-the "straight line" sign-and how to avoid this potentially serious complication by balloon valvuloplasty or by recapture and deployment of a new valve.

Topics: Aged; Alloys; Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Balloon Valvuloplasty; Female; Heart Valve Prosthesis; Hemodynamics; Humans; Prosthesis Design; Prosthesis Failure; Recovery of Function; Severity of Illness Index; Transcatheter Aortic Valve Replacement; Treatment Outcome

Our goal was to assess the viability of an alternative anchoring design for a transcatheter aortic valve based on a form-fitting principle with a self-expanding nitinol frame to reduce issues related to excess radial force.. A 26-mm outer diameter prototype of a self-expanding nitinol frame was developed to reduce the amount of necessary radial force by utilizing additional anchoring via protruding arms in each aortic sinus, thus allowing for a form-fitting principle as well as the coaxial self-alignment of the valve inside the native anatomy. The prototype valve was implanted via a transapical approach in the orthotopic position in 2 sheep. Follow-up examinations were performed at regular intervals during a 3-month period to confirm adequate function and anchoring.. Observation demonstrated secure, facilitated positioning with perfect alignment of the stent in the aortic sinuses. Repeated transthoracic echocardiography showed adequate valve function over the entire period with no change in the valve position, gradients or regurgitation. The animals remained in sinus rhythm during the entire period.. The prototype frame with its form-fitting properties has the potential to resolve issues related to malpositioning and excess radial force for transcatheter aortic valves as well as to extend the treatment possibilities to pure aortic insufficiencies. The stent is presently being tested in vitro for its long-term durability.

Topics: Alloys; Animals; Aortic Valve; Aortic Valve Insufficiency; Chronic Disease; Disease Models, Animal; Echocardiography; Feasibility Studies; Heart Valve Prosthesis; Prosthesis Design; Sheep; Stents; Transcatheter Aortic Valve Replacement

The development of de novo aortic insufficiency (AI) is a significant complication of long-term LVAD support, which can lead to ineffective support, decreased device durability, end organ malperfusion, and increased mortality. Surgical aortic valve (AV) closure has been the standard treatment for symptomatic patients, but is associated with high mortality and recurrence of AI. Percutaneous AV closure using the Amplatzer cribriform device is a feasible and may be the preferable option to treat LVAD-associated severe AI in high-surgical risk patients. Certain technical issues with this procedure should be taken into consideration to achieve optimal results. © 2015 Wiley Periodicals, Inc.

Topics: Aged, 80 and over; Alloys; Aortic Valve; Aortic Valve Insufficiency; Cardiac Catheterization; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Heart Failure; Heart-Assist Devices; Humans; Male; Porosity; Prosthesis Design; Radiography, Interventional; Septal Occluder Device; Treatment Outcome; Ventricular Function, Left

Topics: Alloys; Animals; Aortic Valve; Aortic Valve Insufficiency; Bicuspid Aortic Valve Disease; Cardiac Catheterization; Femoral Artery; Heart Defects, Congenital; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Incidence; Models, Animal; Prosthesis Design; Stents; Treatment Outcome

Topics: Aged, 80 and over; Alloys; Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Bioprosthesis; Cardiac Catheterization; Femoral Artery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Incidence; Prosthesis Design; Treatment Outcome

Topics: Aged, 80 and over; Alloys; Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Balloon Valvuloplasty; Bioprosthesis; Feasibility Studies; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Incidence; Prosthesis Design; Stents; Treatment Outcome

We evaluated transcatheter aortic valve Implantation (TAVI) in high-risk patients with severe aortic regurgitation (AR) in native or degenerated bioprosthetic valves.. TAVI has emerged as a viable treatment modality for severe aortic stenosis in inoperable or high-risk patients. The use of TAVI for treatment of severe AR has remained largely unexplored.. Eight patients (age 79.6 years ± 5.75 years) with severe AR underwent TAVI at six tertiary hospitals between April 2010 and May 2011. All patients were considered to be at prohibitive risk for surgical aortic valve replacement (SAVR).TAVI with the nitinol based Core Valve bioprosthesis (CRS) (Medtronic) was performed in all patients.. Transfemoral access was used in all cases. Procedural success was obtained in all cases without any intraprocedural complications. There was no in hospital or 30-day mortality. There were no cases of atrioventricular blocks requiring permanent pacemaker implantation. At a mean follow up of 15.5 ± 15 months; all patients had improvement in New York Heart Association functional class. Follow up echocardiography revealed improved or stable left ventricular ejection fraction and optimal device function in all cases.. TAVI with the CRS bioprosthesis is feasible and effective in appropriately selected cases of severe aortic regurgitation in native and bioprosthetic aortic valves.

Topics: Aged; Aged, 80 and over; Alloys; Aortic Valve Insufficiency; Bioprosthesis; Cardiac Catheterization; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Italy; Male; Prosthesis Design; Prosthesis Failure; Recovery of Function; Risk Factors; Severity of Illness Index; Stroke Volume; Tertiary Care Centers; Time Factors; Treatment Outcome; Ventricular Function, Left

Topics: Alloys; Aortic Valve; Aortic Valve Insufficiency; Bioprosthesis; Blood Pressure Monitoring, Ambulatory; Cardiac Catheterization; Equipment Design; Heart Valve Prosthesis Implantation; Humans; Miniaturization; Minimally Invasive Surgical Procedures; Prostheses and Implants; Prosthesis Design; Surgical Instruments