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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

A. Fully expanded Edwards Sapien Valve with its stainless steel frame and trileaflet construction made from bovine pericardial tissue. (Published with permission from Edward Lifesciences Inc: Irvine, CA.) B. Fully expanded Medtronic CoreValve with its nitinol frame and trileaflet construction made from porcine pericardial tissue. (Image provided by Medtronic, Inc. In the U.S., the Medtronic CoreValve® System is available for investigational purposes only.)
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Figure 2: A. Fully expanded Edwards Sapien Valve with its stainless steel frame and trileaflet construction made from bovine pericardial tissue. (Published with permission from Edward Lifesciences Inc: Irvine, CA.) B. Fully expanded Medtronic CoreValve with its nitinol frame and trileaflet construction made from porcine pericardial tissue. (Image provided by Medtronic, Inc. In the U.S., the Medtronic CoreValve® System is available for investigational purposes only.)

Mentions: The first transcatheter aortic valve implantations performed in animals were conducted in 1992 by Dr. Andersen and colleagues [10]. It would be another 10 years before Dr. Alan Cribier performed the first in-man TAVR procedure in France in 2002 [11]. In this first case, Dr. Cribier and his colleagues implanted a percutaneous heart valve that consisted of three bovine pericardial leaflets mounted within a tubular stainless steel balloon-expandable stent. Prior to implantation, the stent-valve was securely crimped onto a balloon catheter, which was subsequently advanced across the aortic valve. The balloon was then rapidly inflated and deflated, resulting in successful deployment of the first transcatheter aortic valve in man [11]. Since that first patient in 2002, there has been a rapid growth within the field of structural heart disease and transcatheter valve therapeutics. Five years after Cribier’s first case, TAVR was approved for use in Europe, and since then more than 40,000 patients have been treated worldwide with this technique, which is now indicated as a treatment strategy for both non-surgical patients and patients in high surgical risk groups [1,12-14]. The research and development of transcatheter valves has evolved rapidly as a result of these early successes, and there are currently at least eight valves in commercial development. In the United States, two of these valves are available: the balloon expandable Edwards Sapien prosthesis (Edward Lifesciences Inc: Irvine, CA; Figure 2a) and the Medtronic self-expanding CoreValve ReValving System (Medtronic Inc: Minneapolis, MN; Figure 2b).


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

Forrest JK - Yale J Biol Med (2012)

A. Fully expanded Edwards Sapien Valve with its stainless steel frame and trileaflet construction made from bovine pericardial tissue. (Published with permission from Edward Lifesciences Inc: Irvine, CA.) B. Fully expanded Medtronic CoreValve with its nitinol frame and trileaflet construction made from porcine pericardial tissue. (Image provided by Medtronic, Inc. In the U.S., the Medtronic CoreValve® System is available for investigational purposes only.)
© Copyright Policy - open access
Related In: Results  -  Collection

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

Figure 2: A. Fully expanded Edwards Sapien Valve with its stainless steel frame and trileaflet construction made from bovine pericardial tissue. (Published with permission from Edward Lifesciences Inc: Irvine, CA.) B. Fully expanded Medtronic CoreValve with its nitinol frame and trileaflet construction made from porcine pericardial tissue. (Image provided by Medtronic, Inc. In the U.S., the Medtronic CoreValve® System is available for investigational purposes only.)
Mentions: The first transcatheter aortic valve implantations performed in animals were conducted in 1992 by Dr. Andersen and colleagues [10]. It would be another 10 years before Dr. Alan Cribier performed the first in-man TAVR procedure in France in 2002 [11]. In this first case, Dr. Cribier and his colleagues implanted a percutaneous heart valve that consisted of three bovine pericardial leaflets mounted within a tubular stainless steel balloon-expandable stent. Prior to implantation, the stent-valve was securely crimped onto a balloon catheter, which was subsequently advanced across the aortic valve. The balloon was then rapidly inflated and deflated, resulting in successful deployment of the first transcatheter aortic valve in man [11]. Since that first patient in 2002, there has been a rapid growth within the field of structural heart disease and transcatheter valve therapeutics. Five years after Cribier’s first case, TAVR was approved for use in Europe, and since then more than 40,000 patients have been treated worldwide with this technique, which is now indicated as a treatment strategy for both non-surgical patients and patients in high surgical risk groups [1,12-14]. The research and development of transcatheter valves has evolved rapidly as a result of these early successes, and there are currently at least eight valves in commercial development. In the United States, two of these valves are available: the balloon expandable Edwards Sapien prosthesis (Edward Lifesciences Inc: Irvine, CA; Figure 2a) and the Medtronic self-expanding CoreValve ReValving System (Medtronic Inc: Minneapolis, MN; Figure 2b).

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