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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

Rapid balloon deployment mechanism of Edwards Sapien system. A shows the crimped valve loaded onto the balloon delivery catheter. B shows the valve being deployed by rapid balloon inflation. With deflation of the balloon, the valve maintains its configuration and the balloon catheter can then be removed leaving behind the fully functioning Sapien Valve. (Published with permission from Edward Lifesciences Inc: Irvine, CA.)
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Figure 4: Rapid balloon deployment mechanism of Edwards Sapien system. A shows the crimped valve loaded onto the balloon delivery catheter. B shows the valve being deployed by rapid balloon inflation. With deflation of the balloon, the valve maintains its configuration and the balloon catheter can then be removed leaving behind the fully functioning Sapien Valve. (Published with permission from Edward Lifesciences Inc: Irvine, CA.)

Mentions: The ability to adjust the positioning of the valve during delivery gives the CoreValve a distinct advantage over the Sapien Valve. Due to the self-expanding nature of the Nitinol frame of the CoreValve, the CoreValve can be deployed in stages allowing for subtle adjustments in position during the deployment phases (Figure 3). In contrast, the Sapien Valve is rapidly deployed with a single balloon expansion that does not allow for repositioning either during or after deployment (Figure 4).


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

Forrest JK - Yale J Biol Med (2012)

Rapid balloon deployment mechanism of Edwards Sapien system. A shows the crimped valve loaded onto the balloon delivery catheter. B shows the valve being deployed by rapid balloon inflation. With deflation of the balloon, the valve maintains its configuration and the balloon catheter can then be removed leaving behind the fully functioning Sapien Valve. (Published with permission from Edward Lifesciences Inc: Irvine, CA.)
© Copyright Policy - open access
Related In: Results  -  Collection

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

Figure 4: Rapid balloon deployment mechanism of Edwards Sapien system. A shows the crimped valve loaded onto the balloon delivery catheter. B shows the valve being deployed by rapid balloon inflation. With deflation of the balloon, the valve maintains its configuration and the balloon catheter can then be removed leaving behind the fully functioning Sapien Valve. (Published with permission from Edward Lifesciences Inc: Irvine, CA.)
Mentions: The ability to adjust the positioning of the valve during delivery gives the CoreValve a distinct advantage over the Sapien Valve. Due to the self-expanding nature of the Nitinol frame of the CoreValve, the CoreValve can be deployed in stages allowing for subtle adjustments in position during the deployment phases (Figure 3). In contrast, the Sapien Valve is rapidly deployed with a single balloon expansion that does not allow for repositioning either during or after deployment (Figure 4).

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