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Transcatheter aortic valve replacement: design, clinical application, and future challenges.

Forrest JK - Yale J Biol Med (2012)

Bottom Line: In the United States, there are currently two transcatheter valves available: the Edwards Sapien Valve and the Medtronic CoreValve.While similar in some design elements, they also have characteristic differences that affect both the mechanism of delivery as well as performance in patients.This review aims to take a closer look at the development of this new technology, review the published clinical results, and look toward the future of transcatheter valve therapeutics and the challenges therein.

View Article: PubMed Central - PubMed

Affiliation: Yale School of Medicine, New Haven, CT 06519, USA. john.k.forrest@yale.edu

ABSTRACT
Transcatheter aortic valve replacement (TAVR) is a new technology that recently has been shown to improve survival and quality of life in patients with severe symptomatic aortic stenosis who are not surgical candidates. The development and design of transcatheter valves has been ongoing for the past 20 years, and TAVR has now been approved by the FDA as a treatment for aortic stenosis in patients who are not surgical candidates. In the United States, there are currently two transcatheter valves available: the Edwards Sapien Valve and the Medtronic CoreValve. While similar in some design elements, they also have characteristic differences that affect both the mechanism of delivery as well as performance in patients. This review aims to take a closer look at the development of this new technology, review the published clinical results, and look toward the future of transcatheter valve therapeutics and the challenges therein.

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Related in: MedlinePlus

Anatomy of the human heart demonstrating the four chambers (left and right atria, and left and right ventricles) and the four main valves (mitral, tricuspid, aortic, and pulmonary). The aortic valve is located between the left ventricle and aorta. (Image provided by Medtronic, Inc.)
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Figure 1: Anatomy of the human heart demonstrating the four chambers (left and right atria, and left and right ventricles) and the four main valves (mitral, tricuspid, aortic, and pulmonary). The aortic valve is located between the left ventricle and aorta. (Image provided by Medtronic, Inc.)

Mentions: The aortic valve is one of four valves in the human heart (Figure 1). It is located between the left ventricle and aorta and in 99 percent of individuals is trileaflet in structure (in 1 percent of cases it can be bicuspid or unicuspid). During left ventricular systole (contraction), the pressure in the left ventricle increases until it rises just above the systolic pressure in the aorta. At this point in systole, the aortic valve opens and blood exits the left ventricle into the systemic circulation via the aorta. Thereafter, during left ventricular diastole (relaxation), the pressure in the left ventricle drops, and the pressure in the aorta forces the aortic valve back into its closed position. There are two primary disease processes that can affect the aortic valve: aortic insufficiency and aortic stenosis. In aortic insufficiency, also referred to as aortic regurgitation, the aortic valve is incompetent or leaky, and blood flows back into the left ventricle from the aorta during diastole. In aortic stenosis, the valve fails to open fully, thereby creating a systolic pressure gradient between the left ventricle and aorta. Both of these disease processes can contribute to progressive left ventricular dysfunction and symptomatic heart failure, adversely affecting patient morbidity and mortality.


Transcatheter aortic valve replacement: design, clinical application, and future challenges.

Forrest JK - Yale J Biol Med (2012)

Anatomy of the human heart demonstrating the four chambers (left and right atria, and left and right ventricles) and the four main valves (mitral, tricuspid, aortic, and pulmonary). The aortic valve is located between the left ventricle and aorta. (Image provided by Medtronic, Inc.)
© Copyright Policy - open access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3375667&req=5

Figure 1: Anatomy of the human heart demonstrating the four chambers (left and right atria, and left and right ventricles) and the four main valves (mitral, tricuspid, aortic, and pulmonary). The aortic valve is located between the left ventricle and aorta. (Image provided by Medtronic, Inc.)
Mentions: The aortic valve is one of four valves in the human heart (Figure 1). It is located between the left ventricle and aorta and in 99 percent of individuals is trileaflet in structure (in 1 percent of cases it can be bicuspid or unicuspid). During left ventricular systole (contraction), the pressure in the left ventricle increases until it rises just above the systolic pressure in the aorta. At this point in systole, the aortic valve opens and blood exits the left ventricle into the systemic circulation via the aorta. Thereafter, during left ventricular diastole (relaxation), the pressure in the left ventricle drops, and the pressure in the aorta forces the aortic valve back into its closed position. There are two primary disease processes that can affect the aortic valve: aortic insufficiency and aortic stenosis. In aortic insufficiency, also referred to as aortic regurgitation, the aortic valve is incompetent or leaky, and blood flows back into the left ventricle from the aorta during diastole. In aortic stenosis, the valve fails to open fully, thereby creating a systolic pressure gradient between the left ventricle and aorta. Both of these disease processes can contribute to progressive left ventricular dysfunction and symptomatic heart failure, adversely affecting patient morbidity and mortality.

Bottom Line: In the United States, there are currently two transcatheter valves available: the Edwards Sapien Valve and the Medtronic CoreValve.While similar in some design elements, they also have characteristic differences that affect both the mechanism of delivery as well as performance in patients.This review aims to take a closer look at the development of this new technology, review the published clinical results, and look toward the future of transcatheter valve therapeutics and the challenges therein.

View Article: PubMed Central - PubMed

Affiliation: Yale School of Medicine, New Haven, CT 06519, USA. john.k.forrest@yale.edu

ABSTRACT
Transcatheter aortic valve replacement (TAVR) is a new technology that recently has been shown to improve survival and quality of life in patients with severe symptomatic aortic stenosis who are not surgical candidates. The development and design of transcatheter valves has been ongoing for the past 20 years, and TAVR has now been approved by the FDA as a treatment for aortic stenosis in patients who are not surgical candidates. In the United States, there are currently two transcatheter valves available: the Edwards Sapien Valve and the Medtronic CoreValve. While similar in some design elements, they also have characteristic differences that affect both the mechanism of delivery as well as performance in patients. This review aims to take a closer look at the development of this new technology, review the published clinical results, and look toward the future of transcatheter valve therapeutics and the challenges therein.

Show MeSH
Related in: MedlinePlus