Transcatheter Aortic and Mitral Valve Replacements

Wilson, Roger H. L.; McNabney, Charis; Weir‐McCall, Jonathan R.; Sellers, Stephanie; Blanke, Philipp; Leipsic, Jonathon

doi:10.1016/j.rcl.2018.08.001

Cited by 10 publications

(3 citation statements)

References 73 publications

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“…Essentially, it is more difficult to anchor the mitral valve prosthesis because unlike TAVR, the valve fixation cannot be dependent only on radial forces [7]. Advances made by radiologists in computed tomography have become important to address these issues [9]. Another issue lies in the fact that many patients for whom TMVR, rather than repair, is suitable (patients at high surgical risk with functional secondary mitral regurgitation) also have tricuspid regurgitation and atrial fibrillation.…”

Section: Device Backgroundmentioning

confidence: 99%

Analyzing Adverse Events of Mitral and Aortic Valves during the Pandemic

Zhou¹,

Bhatia²

2022

JBEB

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The COVID-19 pandemic forced cardiologists to adapt to unprecedented circumstances. We chose to investigate the pandemic's effect on heart valve replacements, in particular focussing on device failure in mitral valve replacements and percutaneous aortic valve prostheses. In order to measure this effect, we examined adverse event reports of these two devices in the Food and Drug Administration (FDA)'s Manufacturer and User Facility Device Experience (MAUDE) database. We compared weekly numbers of adverse event reports during the pandemic (March 2020-March 2021 to those of the year before (March 2019-March 2020. We find that reports of deaths, injuries, and malfunctions attributed to mitral valve repair devices all showed no significant changes during the pandemic, compared to the year preceding. However, we have also found that during the pandemic, there was a 107.4% increase in deaths reported to the FDA that were attributed to percutaneous aortic valve prostheses, and a 45.1% increase in reports of malfunctions as well compared to the year preceding the pandemic. These results suggest that the pandemic may have induced an increase in transcatheter aortic valve replacements vs. surgical aortic valve replacements, leading to an increase in adverse event reports associated with percutaneous aortic valve prostheses. In contrast, transcatheter mitral valve repair is not commonly performed, and the pandemic is unlikely to have changed treatment protocols for mitral valve repair.

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Section: Device Backgroundmentioning

confidence: 99%

Analyzing Adverse Events of Mitral and Aortic Valves during the Pandemic

Zhou¹,

Bhatia²

2022

JBEB

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“…While radiation exposure must always remain a point of focus, one can pragmatically defend the notion that given the very advanced age of a typical TAVI candidate and the dismal short-term prognosis of an untreated symptomatic severe AS, aggressive reduction of radiation exposure is currently not a primary concern in this population. However, as the transcatheter approach for treating valvular heart disease expands to other valves, and within the aortic valve to other indications and population groups, it can be expected that the mean patient age will further decrease [15,[53][54][55]. Therefore, with an increased associated life expectancy, together with a not yet exactly defined potential role of CT in the management of manifestations such as subclinical valve leaflet thrombosis, radiation exposure and the efforts to reduce it will only gain in importance.…”

Section: Radiation Exposurementioning

confidence: 99%

Transcatheter Aortic Valve Implantation: The Evolving Role of the Radiologist in 2021

Salgado¹,

Addouli²,

Budde

2021

Rofo

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Background Transcatheter aortic valve implantation (TAVI) has gained worldwide acceptance and implementation as an alternative therapeutic option in patients with severe aortic valve stenosis unable to safely undergo surgical aortic valve replacement. This transformative technique places the radiologist in a key position in the pre-procedural assessment of potential candidates for this technique, delivering key anatomical information necessary for patient eligibility and procedural safety. Recent trials also provide encouraging results to potentially extend the indication to patients with safer risk profiles. Method The review is based on a PubMed literature search using the search terms “transcatheter heart valve”, “TAVI”, “TAVR”, “CT”, “imaging”, “MR” over a period from 2010–2020, combined with personal comments based on the author’s experience. Results and Conclusion CT plays a prominent role in the pre-procedural workup, delivering as a true 3D imaging modality optimal visualization of the complex anatomy of the aortic root with simultaneous evaluation of the patency of the different access routes. As such, the contribution of CT is key for the determination of patient eligibility and procedural safety. This input is supplementary to the contributions of other imaging modalities and forms an important element in the discussions of the Heart Valve Team. Knowledge of the procedure and its characteristics is necessary in order to provide a comprehensive and complete report. While the role of CT in the pre-procedural evaluation is well established, the contribution of CT and MR and the clinical significance of their findings in the routine follow-up after the intervention are less clear and currently the subject of intense investigation. Important issues remain, including the occurrence and significance of subclinical leaflet thrombosis, prosthetic heart valve endocarditis, and long-term structural valve degeneration. Key Points: Citation Format

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“…Good performance of mitral valve stent products needs to meet many conditions [6] and be capable of being pressed into a delivery system; the stress on the stent must be lower than the ultimate tensile strength of the stent material after implantation; it must maintain good hemodynamic performance; and the radial support force of the stent must not damage the mitral ring. Currently prevalent aortic intervention valves used in clinical practice have a circular cross-sectional shape [7]. Circular stents cannot expand into their original shape after implantation, which leads to problems such as poor valve lobe closure and lack of tight fitting with the forming ring.…”

Section: Introductionmentioning

confidence: 99%

Mechanical Analysis of the Connection Structure of a Double-Layered Valve Stent within an Annuloplasty Ring

Dong,

2024

HSF

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Background: In this study, to address the failure of mitral valve repair surgery, a novel valve-in-ring model for an artificial mitral valve annuloplasty ring and a new double-layer mitral valve were established. A suitable number and length of ventricular fixation struts within the annuloplasty ring, as well as the implantation depth, result in variations in stress and strain for the inner and outer stent layers. Methods: The compression and self-expansion model of the stent was established via finite element analysis. The changes in stress and strain were analyzed by setting the length and number of the ventricular fixed struts and implantation depth. Results: When only affected by factors such as blood pressure, the maximum stresses of stent structures with three and six ventricular fixed struts are 476 and 222 MPa, respectively, in the right posterior annular region. At implantation depths of 0, 0.5, 1, and 2 mm, the maximum stresses are located in the left posterior annular region of the outer stent and are 740, 697, 709, and 742 MPa, respectively, and the maximum displacements of the inner stent are all in the right posterior ventricular fixed strut region of the posterior annulus and are 3.71, 3.10, 2.48, and 1.87 mm, respectively. In the three and six ventricular fixed strut stents, when the ventricular fixed strut length is 3, 4, and 5 mm, the maximum stresses are 570, 557, and 621 MPa and 674, 666, 644 MPa, respectively. Conclusions: Appropriately increasing the number of ventricular fixed struts can effectively reduce damage to the stent inside the body, and the damage to the stent is relatively consistent across different implantation depths; however, the right side of the stent's posterior annulus is particularly susceptible to damage. However, if the implantation depth is lower, the impact on the inner stent will be more significant. As the number of ventricular fixed struts increases, the strut length variation has a relatively stable impact on stent damage.

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Transcatheter Aortic and Mitral Valve Replacements

Cited by 10 publications

References 73 publications

Analyzing Adverse Events of Mitral and Aortic Valves during the Pandemic

Analyzing Adverse Events of Mitral and Aortic Valves during the Pandemic

Transcatheter Aortic Valve Implantation: The Evolving Role of the Radiologist in 2021

Mechanical Analysis of the Connection Structure of a Double-Layered Valve Stent within an Annuloplasty Ring

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