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Kono T, Takagi K, Takaseya T, Fukuda T, Saku K, Zaima Y, Shojima T, Arinaga K, Tayama E. Early thrombus formation including hypo-attenuated leaflet thrombosis after surgical bioprosthetic aortic valve replacement. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02010-4. [PMID: 38403822 DOI: 10.1007/s11748-024-02010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To assess the occurrence, predictors, and outcomes of hypo-attenuated leaflet thickening (HALT) and thrombus outside the prosthetic valve following surgical aortic valve replacement. METHODS A total of 118 patients underwent surgical aortic valve replacement with bioprosthetic valves between July 2020 and June 2022. Sixty-two (52.5%) patients, which is a fairly high number of patients, underwent cardiac computed tomography and transthoracic echocardiography one week after surgery. Patients were divided into two groups, those with HALT (n = 14) and those without HALT (n = 48). RESULTS Of the 62 patients who underwent cardiac computed tomography, HALT was observed in 14 (22.5%) patients during the very early postoperative phase. Reduced leaflet motion was observed in two of the 14 patients. The low-attenuation areas were located outside the prosthetic valve in 10 cases (71.4%) in the HALT group and in 14 cases (29.2%) in the non-HALT group. More than 50% of patients (57.1%) with HALT and 79.2% without HALT were administered warfarin. Neither in-hospital deaths nor postoperative thromboembolic events were observed during hospitalization. No patient had a mean pressure gradient > 20 mmHg in either group. CONCLUSION HALT was observed in one-fifth of the cases after surgical aortic valve replacement during the very early postoperative phase in an institution wherein administration of continuous heparin infusion after surgery is a standard practice. HALT did not affect the early prognosis or incidence of cerebral infarction.
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Affiliation(s)
- Takanori Kono
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomofumi Fukuda
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yasuyuki Zaima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Koichi Arinaga
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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Moscarelli M, Prestera R, Pernice V, Milo S, Violante F, Cuffari F, Di Pasquale C, Ferlisi A, Speziale G, Angelini GD, Fattouch K. Subclinical Leaflet Thrombosis Following Surgical and Transcatheter Aortic Valve Replacement: A Meta-Analysis. Am J Cardiol 2023; 204:171-177. [PMID: 37544140 DOI: 10.1016/j.amjcard.2023.07.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Abstract
Subclinical leaflets valve thrombosis (SLT) is a recently identified phenomenon with multidetector computer tomography after tissue aortic valve replacement. Whether SLT is more frequent after transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) is currently not known. Thus, the aim of this pairwise meta-analysis was to investigate the incidence of SLT after both TAVR and SAVR, the association with anticoagulation therapy, and the risk for neurological events. We searched PubMed, Google Scholar, and Ovid MEDLINE/Embase (January 02, 2023, last update) (PROSPERO registration: CRD42022383295). Statistical analysis was performed according to a prespecified statistical analysis plan. Time-to-event outcomes were summarized as incidence rate ratios (IRR). Pooled estimates were calculated using inverse variance method and random effect model. Overall, 2 registries, 2 randomized trials, and 1 observational study (1,593 patients) were included in this meta-analysis. There was a statistically significant difference in the incidence rate at follow-up of SLT between patients who underwent TAVR and SAVR (IRR 2.07, 95% confidence interval [CI]: [1.06; 4.03], I2 79%, 95% CI: [44; 92], p = 0.03). Oral anticoagulation therapy was associated with a reduced incidence of SLT (IRR 7.51, 95% CI: [3.24; 17.37], I2 62%, 95% CI: [0; 87], p <0.001). However, the incidence of later neurological events did not differ between patients with or without SLT (IRR 1.05, 95% CI: [0.32; 3.47], p = 0.93). In conclusion, SLT was more frequently detected after TAVR than SAVR. However, it was not associated with an increased risk for neurological events. Oral anticoagulation therapy seemed to reduce the incidence of SLT.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy.
| | - Rosa Prestera
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Vincenzo Pernice
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Sabrina Milo
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Francesco Violante
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Federico Cuffari
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Claudia Di Pasquale
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Angelo Ferlisi
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Giuseppe Speziale
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, United Kingdom
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy; DICHIRONS, Discipline Chirurgiche, Oncologiche e Stomatologiche, University of Palermo, Palermo, Italy
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3
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Singh SK, Kachel M, Castillero E, Xue Y, Kalfa D, Ferrari G, George I. Polymeric prosthetic heart valves: A review of current technologies and future directions. Front Cardiovasc Med 2023; 10:1137827. [PMID: 36970335 PMCID: PMC10034107 DOI: 10.3389/fcvm.2023.1137827] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/09/2023] [Indexed: 03/11/2023] Open
Abstract
Valvular heart disease is an important source of cardiovascular morbidity and mortality. Current prosthetic valve replacement options, such as bioprosthetic and mechanical heart valves are limited by structural valve degeneration requiring reoperation or the need for lifelong anticoagulation. Several new polymer technologies have been developed in recent years in the hope of creating an ideal polymeric heart valve substitute that overcomes these limitations. These compounds and valve devices are in various stages of research and development and have unique strengths and limitations inherent to their properties. This review summarizes the current literature available for the latest polymer heart valve technologies and compares important characteristics necessary for a successful valve replacement therapy, including hydrodynamic performance, thrombogenicity, hemocompatibility, long-term durability, calcification, and transcatheter application. The latter portion of this review summarizes the currently available clinical outcomes data regarding polymeric heart valves and discusses future directions of research.
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Affiliation(s)
- Sameer K. Singh
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Mateusz Kachel
- Cardiovascular Research Foundation, New York, NY, United States
- American Heart of Poland, Center for Cardiovascular Research and Development, Katowice, Poland
| | - Estibaliz Castillero
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Yingfei Xue
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - David Kalfa
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Giovanni Ferrari
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Isaac George
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York, NY, United States
- *Correspondence: Isaac George,
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4
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Feng W, Yang X, Yao J, Feng C, Wang L, Fan Y. Bovine pericardium leaflet damage during transcatheter aortic valve crimping: a study of the mechanisms. Comput Methods Biomech Biomed Engin 2022:1-10. [PMID: 35951008 DOI: 10.1080/10255842.2022.2110378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Leaflet damage has been documented to occur while deploying a transcatheter aortic valve (TAV) due to mechanical loads during the crimping procedures. In this study, the impact of compressive stress on folded leaflets was measured to investigate the mechanism of traumatic leaflet tissue damage. Numerical simulation of TAV crimping procedure was adapted to calculate stress magnitude and distribution of leaflets. A 20 mm balloon expanding short stent TAV with 0.25 mm thickness leaflets was used in the simulation. Then the calculated stresses were applied on leaflet material (bovine pericardium) samples by loading experiments. Mechanical properties evaluation combined with histological and microscopy observation were used to investigate the tissue damage. The elastic modulus and the tensile strength of the tissue began to decrease significantly at 2 MPa stress and 2.5 MPa stress, respectively. No significant differences were observed at 0-1.5 MPa stress. When the TAV was crimped to 14 Fr and 12 Fr, the 2 MPa greater areas on leaflets increased from 18.17% to 76.96%. 2 MPa compressive stress might be the threshold value for leaflet damage. The TAV crimping size should be paid attention to avoid the compressive stress higher than 2 MPa.
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Affiliation(s)
- Wentao Feng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xianda Yang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jie Yao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Chenglong Feng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Lizhen Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, Beijing, China
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5
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Chambers JB. Leaflet thrombosis in transcatheter aortic valves implants: a new marker of risk? Eur Heart J Cardiovasc Imaging 2020; 21:1090-1091. [PMID: 32617575 DOI: 10.1093/ehjci/jeaa158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- John B Chambers
- Cardiothoracic Centre, Guy's and St Thomas' Hospitals, Westminster Bridge Road, London SE1 7EH, UK
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6
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Aktuerk D, Mirsadraee S, Quarto C, Davies S, Duncan A. Leaflet thrombosis after valve-in-valve transcatheter aortic valve implantation: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 32974465 DOI: 10.1093/ehjcr/ytaa221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/14/2020] [Accepted: 06/19/2020] [Indexed: 01/09/2023]
Abstract
Background Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) in degenerated surgical aortic valve replacement (SAVR) is an alternative to redo-SAVR. However, reports on leaflet thrombosis following ViV-TAVI are emerging and subclinical thrombosis has gained recent attention. Although the incidence of transcatheter heart valve (THV) thrombosis after TAVI for native aortic valve disease is low, current imaging studies suggest the incidence of subclinical THV thrombosis may be significantly higher. While anticoagulation strategies for THV patients for native aortic stenosis presenting with symptomatic obstructive thrombosis has been described, the optimal management and anticoagulation therapy of patients with THV thrombosis following ViV-TAVI are less evident. Case summary We report a case series of three patients presenting with early and late THV thrombosis after ViV-TAVI. Two patients presented clinically on single antiplatelet therapy and one patient presented with subclinical valve thrombosis whilst taking a non-vitamin K oral anticoagulation agent. Discussion Leaflet thrombosis after ViV-TAVI is an important cause of THV degeneration and may present subclinically. Imaging modalities such as serial transthoracic echocardiograms and multidetector computerized tomography aid diagnosis and guide management. Patient-individualized risk- vs. -benefit prophylactic post-procedural oral anticoagulation may be indicated.
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Affiliation(s)
- Dincer Aktuerk
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, Sydney Street, Chelsea, London SW36NP, UK
| | - Saeed Mirsadraee
- Department of Radiology, Royal Brompton Hospital, Sydney Street, Chelsea, London SW36NP, UK
| | - Cesare Quarto
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, Sydney Street, Chelsea, London SW36NP, UK
| | - Simon Davies
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, Chelsea, London SW36NP, UK
| | - Alison Duncan
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, Chelsea, London SW36NP, UK
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7
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In Vitro Durability and Stability Testing of a Novel Polymeric Transcatheter Aortic Valve. ASAIO J 2020; 66:190-198. [PMID: 30845067 DOI: 10.1097/mat.0000000000000980] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as an effective therapy for the unmet clinical need of inoperable patients with severe aortic stenosis (AS). Current clinically used tissue TAVR valves suffer from limited durability that hampers TAVR's rapid expansion to younger, lower risk patients. Polymeric TAVR valves optimized for hemodynamic performance, hemocompatibility, extended durability, and resistance to calcific degeneration offer a viable solution to this challenge. We present extensive in vitro durability and stability testing of a novel polymeric TAVR valve (PolyNova valve) using 1) accelerated wear testing (AWT, ISO 5840); 2) calcification susceptibility (in the AWT)-compared with clinically used tissue valves; and 3) extended crimping stability (valves crimped to 16 Fr for 8 days). Hydrodynamic testing was performed every 50M cycles. The valves were also evaluated visually for structural integrity and by scanning electron microscopy for evaluation of surface damage in the micro-scale. Calcium and phosphorus deposition was evaluated using micro-computed tomography (μCT) and inductive coupled plasma spectroscopy. The valves passed 400M cycles in the AWT without failure. The effective orifice area kept stable at 1.8 cm with a desired gradual decrease in transvalvular pressure gradient and regurgitation (10.4 mm Hg and 6.9%, respectively). Calcium and phosphorus deposition was significantly lower in the polymeric valve: down by a factor of 85 and 16, respectively-as compared to a tissue valve. Following the extended crimping testing, no tears nor surface damage were evident. The results of this study demonstrate the potential of a polymeric TAVR valve to be a viable alternative to tissue-based TAVR valves.
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8
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Subclinical Leaflet Thrombosis in Transcatheter and Surgical Bioprosthetic Valves. J Am Coll Cardiol 2020; 75:3003-3015. [DOI: 10.1016/j.jacc.2020.04.043] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022]
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9
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Sellers SL, Sathananthan J, Bouchareb R, Mostaço-Guidolin LB, Lau KPL, Bugis J, Hensey M, Blanke P, Payne GW, Lebeche D, Pibarot P, Hackett TL, Webb JG, Leipsic JA. Impact of Over-Expansion on SAPIEN 3 Transcatheter Heart Valve Pericardial Leaflets. STRUCTURAL HEART 2020. [DOI: 10.1080/24748706.2020.1742950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Zareian R, Tseng JC, Fraser R, Meganck J, Kilduff M, Sarraf M, Dvir D, Kheradvar A. Effect of stent crimping on calcification of transcatheter aortic valves. Interact Cardiovasc Thorac Surg 2019; 29:64-73. [PMID: 30793744 DOI: 10.1093/icvts/ivz024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/26/2018] [Accepted: 12/27/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although many challenges related to the acute implantation of transcatheter aortic valves have been resolved, durability and early degeneration are currently the main concerns. Recent reports indicate the potential for early valve degeneration and calcification. However, only little is known about the underlying mechanisms behind the early degeneration of these valves. The goal of this study was to test whether stent crimping increases the risk for early calcification. METHODS Stented valves that were crimped at 18-Fr and 14-Fr catheter and uncrimped controls were exposed to a standard calcifying solution for 50 million cycles in an accelerated wear test system. Subsequently, the leaflets of the valves were imaged by microcomputed tomography (micro-CT) followed by histochemical staining and microscopic analyses to quantify calcification and other changes in the leaflets' characteristics. RESULTS Heavily calcified regions were found over the stent-crimped leaflets compared to uncrimped controls, particularly around the stent's struts. Micro-CT studies measured the total volume of calcification in the uncrimped valves as 77.31 ± 1.63 mm3 vs 95.32 ± 5.20 mm3 in 18-Fr and 110.01 ± 8.33 mm3 in 14-Fr stent-crimped valves, respectively. These results were congruent with the increase in leaflet thickness measured by CT scans (0.44 ± 0.07 mm in uncrimped valves vs 0.69 ± 0.15 mm and 0.75 ± 0.09 mm in 18-Fr and 14-Fr stent-crimped valves, respectively). Histological studies confirmed the micro-CT results, denoting that the percentage of calcification in uncrimped leaflets at the valve's posts was 5.34 ± 3.97 compared to 19.97 ± 6.18 and 27.64 ± 13.17 in the 18-Fr and 14-Fr stent-crimped leaflets, respectively. CONCLUSIONS This study concludes that stent-crimping damage is associated with a higher level of passive leaflet calcification, which may contribute to early valve degeneration.
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Affiliation(s)
- Ramin Zareian
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine, Irvine, CA, USA
| | | | | | | | | | - Mohammad Sarraf
- Cardiovascular Division, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Danny Dvir
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Arash Kheradvar
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine, Irvine, CA, USA
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Rotman OM, Bianchi M, Ghosh RP, Kovarovic B, Bluestein D. Principles of TAVR valve design, modelling, and testing. Expert Rev Med Devices 2018; 15:771-791. [PMID: 30318937 DOI: 10.1080/17434440.2018.1536427] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has emerged as an effective minimally-invasive alternative to surgical valve replacement in medium- to high-risk, elderly patients with calcific aortic valve disease and severe aortic stenosis. The rapid growth of the TAVR devices market has led to a high variety of designs, each aiming to address persistent complications associated with TAVR valves that may hamper the anticipated expansion of TAVR utility. AREAS COVERED Here we outline the challenges and the technical demands that TAVR devices need to address for achieving the desired expansion, and review design aspects of selected, latest generation, TAVR valves of both clinically-used and investigational devices. We further review in detail some of the up-to-date modeling and testing approaches for TAVR, both computationally and experimentally, and additionally discuss those as complementary approaches to the ISO 5840-3 standard. A comprehensive survey of the prior and up-to-date literature was conducted to cover the most pertaining issues and challenges that TAVR technology faces. EXPERT COMMENTARY The expansion of TAVR over SAVR and to new indications seems more promising than ever. With new challenges to come, new TAV design approaches, and materials used, are expected to emerge, and novel testing/modeling methods to be developed.
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Affiliation(s)
- Oren M Rotman
- a Department of Biomedical Engineering , Stony Brook University , Stony Brook , NY , USA
| | - Matteo Bianchi
- a Department of Biomedical Engineering , Stony Brook University , Stony Brook , NY , USA
| | - Ram P Ghosh
- a Department of Biomedical Engineering , Stony Brook University , Stony Brook , NY , USA
| | - Brandon Kovarovic
- a Department of Biomedical Engineering , Stony Brook University , Stony Brook , NY , USA
| | - Danny Bluestein
- a Department of Biomedical Engineering , Stony Brook University , Stony Brook , NY , USA
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12
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Rashid HN, Brown AJ, McCormick LM, Amiruddin AS, Be KK, Cameron JD, Nasis A, Gooley RP. Subclinical Leaflet Thrombosis in Transcatheter Aortic Valve Replacement Detected by Multidetector Computed Tomography ― A Review of Current Evidence ―. Circ J 2018; 82:1735-1742. [DOI: 10.1253/circj.cj-17-1363] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hashrul N. Rashid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health
| | - Adam J. Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health
| | - Liam M. McCormick
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health
| | - Ameera S. Amiruddin
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health
| | - Kim K. Be
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health
| | - James D. Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health
| | - Arthur Nasis
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health
| | - Robert P. Gooley
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health
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13
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Convelbo C, El Hafci H, Petite H, Zegdi R. Traumatic leaflet injury: comparison of porcine leaflet self-expandable and bovine leaflet balloon-expandable prostheses. Eur J Cardiothorac Surg 2017; 53:1062-1067. [DOI: 10.1093/ejcts/ezx451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/18/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Channing Convelbo
- CNRS UMR 7052 Osteo-Articular Bioengineering and Bioimaging Laboratory (B2OA), Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Hanane El Hafci
- CNRS UMR 7052 Osteo-Articular Bioengineering and Bioimaging Laboratory (B2OA), Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Hervé Petite
- CNRS UMR 7052 Osteo-Articular Bioengineering and Bioimaging Laboratory (B2OA), Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Rachid Zegdi
- Paris-Est Créteil University (Paris XII), Créteil, France
- AP-HP, Henri Mondor Hospital, Créteil, France
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14
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Chakravarty T, Søndergaard L, Friedman J, De Backer O, Berman D, Kofoed KF, Jilaihawi H, Shiota T, Abramowitz Y, Jørgensen TH, Rami T, Israr S, Fontana G, de Knegt M, Fuchs A, Lyden P, Trento A, Bhatt DL, Leon MB, Makkar RR. Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. Lancet 2017; 389:2383-2392. [PMID: 28330690 DOI: 10.1016/s0140-6736(17)30757-2] [Citation(s) in RCA: 622] [Impact Index Per Article: 88.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Subclinical leaflet thrombosis of bioprosthetic aortic valves after transcatheter valve replacement (TAVR) and surgical aortic valve replacement (SAVR) has been found with CT imaging. The objective of this study was to report the prevalence of subclinical leaflet thrombosis in surgical and transcatheter aortic valves and the effect of novel oral anticoagulants (NOACs) on the subclinical leaflet thrombosis and subsequent valve haemodynamics and clinical outcomes on the basis of two registries of patients who had CT imaging done after TAVR or SAVR. METHODS Patients enrolled between Dec 22, 2014, and Jan 18, 2017, in the RESOLVE registry, and between June 2, 2014, and Sept 28, 2016, in the SAVORY registry, had CT imaging done with a dedicated four-dimensional volume-rendered imaging protocol at varying intervals after TAVR and SAVR. We defined subclinical leaflet thrombosis as the presence of reduced leaflet motion, along with corresponding hypoattenuating lesions shown with CT. We collected data for baseline demographics, antithrombotic therapy, and clinical outcomes. We analysed all CT scans, echocardiograms, and neurological events in a masked fashion. FINDINGS Of the 931 patients who had CT imaging done (657 [71%] in the RESOLVE registry and 274 [29%] in the SAVORY registry), 890 [96%] had interpretable CT scans (626 [70%] in the RESOLVE registry and 264 [30%] in the SAVORY registry). 106 (12%) of 890 patients had subclinical leaflet thrombosis, including five (4%) of 138 with thrombosis of surgical valves versus 101 (13%) of 752 with thrombosis of transcatheter valves (p=0·001). The median time from aortic valve replacement to CT for the entire cohort was 83 days (IQR 33-281). Subclinical leaflet thrombosis was less frequent among patients receiving anticoagulants (eight [4%] of 224) than among those receiving dual antiplatelet therapy (31 [15%] of 208; p<0·0001); NOACs were equally as effective as warfarin (three [3%] of 107 vs five [4%] of 117; p=0·72). Subclinical leaflet thrombosis resolved in 36 (100%) of 36 patients (warfarin 24 [67%]; NOACs 12 [33%]) receiving anticoagulants, whereas it persisted in 20 (91%) of 22 patients not receiving anticoagulants (p<0·0001). A greater proportion of patients with subclinical leaflet thrombosis had aortic valve gradients of more than 20 mm Hg and increases in aortic valve gradients of more than 10 mm Hg (12 [14%] of 88) than did those with normal leaflet motion (seven [1%] of 632; p<0·0001). Although stroke rates were not different between those with (4·12 strokes per 100 person-years) or without (1·92 strokes per 100 person-years) reduced leaflet motion (p=0·10), subclinical leaflet thrombosis was associated with increased rates of transient ischaemic attacks (TIAs; 4·18 TIAs per 100 person-years vs 0·60 TIAs per 100 person-years; p=0·0005) and all strokes or TIAs (7·85 vs 2·36 per 100 person-years; p=0·001). INTERPRETATION Subclinical leaflet thrombosis occurred frequently in bioprosthetic aortic valves, more commonly in transcatheter than in surgical valves. Anticoagulation (both NOACs and warfarin), but not dual antiplatelet therapy, was effective in prevention or treatment of subclinical leaflet thrombosis. Subclinical leaflet thrombosis was associated with increased rates of TIAs and strokes or TIAs. Despite excellent outcomes after TAVR with the new-generation valves, prevention and treatment of subclinical leaflet thrombosis might offer a potential opportunity for further improvement in valve haemodynamics and clinical outcomes. FUNDING RESOLVE (Cedars-Sinai Heart Institute) and SAVORY (Rigshospitalet).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Tanya Rami
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | - Gregory Fontana
- Cardiovascular Institute, Los Robles Hospital and Medical Center, Thousand Oaks, CA, USA
| | | | | | | | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Martin B Leon
- Columbia University Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Raj R Makkar
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
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15
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Gaia DF, Braz AM, Simonato M, Dvir D, Breda JR, Ribeiro GC, Ferreira CB, Souza JAM, Buffolo E, Palma JH. Mitral implant of the Inovare transcatheter heart valve in failed surgical bioprostheses: a novel alternative for valve-in-valve procedures. Interact Cardiovasc Thorac Surg 2017; 24:514-520. [PMID: 28077510 DOI: 10.1093/icvts/ivw368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/10/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives Reoperative procedure for the treatment of a failed mitral bioprosthesis is associated with considerable risk. In some cases, mortality is high and might contraindicate the benefit of the procedure. The minimally invasive valve-in-valve (ViV) transcatheter mitral valve implant offers an alternative less-invasive approach, reducing morbidity and mortality. The objective of this paper was to evaluate the mitral ViV approach using the Braile Inovare prosthesis. Methods The transcatheter balloon-expandable Braile Inovare prosthesis was used in 12 cases. Procedures were performed in a hybrid operating room, under fluoroscopic and echocardiographic control. Through left minithoracotomy, the prostheses were implanted through the cardiac apex. Serial echocardiographic and clinical examinations were performed. Follow-up varied from 1 to 30 months. Results A total of 12 transapical mitral ViV procedures were performed. Patients had a mean age of 61.6 ± 9.9 years and 92% were women. Mean logistic EuroSCORE was 20.1%. Successful valve implantation was possible in all cases. In one case, a right lateral thoracotomy was performed for the removal of an embolized prosthesis. There was no operative mortality. Thirty-day mortality was 8.3%. Ejection fraction was preserved after the implant (66.7%; 64.8%; P = 0.3). The mitral gradient showed a significant reduction (11 mmHg; 6 mmHg; P < 0.001). Residual mitral regurgitation was not present. There was no left ventricular outflow tract obstruction. Conclusions The mitral ViV implant in a failed bioprosthesis is an effective procedure. This possibility might alter prosthesis selection in the future initial surgical prosthesis selection, favouring bioprostheses. Further large trials should explore its safety.
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Affiliation(s)
- Diego Felipe Gaia
- Division of Cardiovascular Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Ademir Massarico Braz
- Division of Cardiovascular Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Matheus Simonato
- Division of Cardiovascular Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, USA
| | - João Roberto Breda
- Division of Cardiovascular Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | | | - Carolina Baeta Ferreira
- Division of Anesthesia, Pain and Intensive Care, Federal University of São Paulo, São Paulo, Brazil
| | - José Augusto Marcondes Souza
- Division of Cardiology, Department of Interventional Cardiology, Federal University of São Paulo, São Paulo, Brazil
| | - Enio Buffolo
- Division of Cardiovascular Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - José Honório Palma
- Division of Cardiovascular Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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Dasi LP, Hatoum H, Kheradvar A, Zareian R, Alavi SH, Sun W, Martin C, Pham T, Wang Q, Midha PA, Raghav V, Yoganathan AP. On the Mechanics of Transcatheter Aortic Valve Replacement. Ann Biomed Eng 2017; 45:310-331. [PMID: 27873034 PMCID: PMC5300937 DOI: 10.1007/s10439-016-1759-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/03/2016] [Indexed: 01/22/2023]
Abstract
Transcatheter aortic valves (TAVs) represent the latest advances in prosthetic heart valve technology. TAVs are truly transformational as they bring the benefit of heart valve replacement to patients that would otherwise not be operated on. Nevertheless, like any new device technology, the high expectations are dampened with growing concerns arising from frequent complications that develop in patients, indicating that the technology is far from being mature. Some of the most common complications that plague current TAV devices include malpositioning, crimp-induced leaflet damage, paravalvular leak, thrombosis, conduction abnormalities and prosthesis-patient mismatch. In this article, we provide an in-depth review of the current state-of-the-art pertaining the mechanics of TAVs while highlighting various studies guiding clinicians, regulatory agencies, and next-generation device designers.
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Affiliation(s)
- Lakshmi P Dasi
- Department of Biomedical Engineering, Dorothy Davis Heart and Lung Research Institute, The Ohio State University, 473 W 12th Avenue, Columbus, OH, 43210, USA.
| | - Hoda Hatoum
- Department of Biomedical Engineering, Dorothy Davis Heart and Lung Research Institute, The Ohio State University, 473 W 12th Avenue, Columbus, OH, 43210, USA
| | - Arash Kheradvar
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, Department of Biomedical Engineering, University of California, Irvine, CA, 92697, USA
| | - Ramin Zareian
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, Department of Biomedical Engineering, University of California, Irvine, CA, 92697, USA
| | - S Hamed Alavi
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, Department of Biomedical Engineering, University of California, Irvine, CA, 92697, USA
| | - Wei Sun
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Caitlin Martin
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Thuy Pham
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Qian Wang
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Prem A Midha
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Vrishank Raghav
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
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Rahmani B, Tzamtzis S, Sheridan R, Mullen MJ, Yap J, Seifalian AM, Burriesci G. In Vitro Hydrodynamic Assessment of a New Transcatheter Heart Valve Concept (the TRISKELE). J Cardiovasc Transl Res 2016; 10:104-115. [PMID: 28028692 PMCID: PMC5437138 DOI: 10.1007/s12265-016-9722-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/21/2016] [Indexed: 11/01/2022]
Abstract
This study presents the in vitro hydrodynamic assessment of the TRISKELE, a new system suitable for transcatheter aortic valve implantation (TAVI), aiming to mitigate the procedural challenges experienced with current technologies. The TRISKELE valve comprises three polymeric leaflet and an adaptive sealing cuff, supported by a novel fully retrievable self-expanding nitinol wire frame. Valve prototypes were manufactured in three sizes of 23, 26, and 29 mm by automated dip-coating of a biostable polymer, and tested in a hydrodynamic bench setup in mock aortic roots of 21, 23, 25, and 27 mm annulus, and compared to two reference valves suitable for equivalent implantation ranges: Edwards SAPIEN XT and Medtronic CoreValve. The TRISKELE valves demonstrated a global hydrodynamic performance comparable or superior to the controls with significant reduction in paravalvular leakage. The TRISKELE valve exhibits enhanced anchoring and improved sealing. The valve is currently under preclinical investigation.
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Affiliation(s)
- Benyamin Rahmani
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Spyros Tzamtzis
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Rose Sheridan
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Michael J Mullen
- Barts Health NHS Trust, University College London Hospital, London, UK
| | - John Yap
- Barts Health NHS Trust, University College London Hospital, London, UK
| | | | - Gaetano Burriesci
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK. .,Ri.MED Foundation, Bioengineering Group, Palermo, Italy.
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18
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Guidoin R, Zegdi R, Lin J, Mao J, Rochette-Drouin O, How D, Guan X, Bruneval P, Wang L, Germain L, Zhang Z. Transcatheter heart valve crimping and the protecting effects of a polyester cuff. Morphologie 2016; 100:234-244. [PMID: 27461102 DOI: 10.1016/j.morpho.2016.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/16/2016] [Accepted: 06/21/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Prior to deployment, the percutaneous heart valves must be crimped and loaded into sheaths of diameters that can be as low as 6mm for a 23mm diameter valve. However, as the valve leaflets are fragile, any damage caused during this crimping process may contribute to reducing its long-term durability in vivo. MATERIAL AND METHOD Bovine pericardium percutaneous valves were manufactured as follows. The leaflets were sutured on a nitinol frame. A polyester cuff fabric served as a buffer between the pericardium and the stent. Two valves were crimped and one valve was used as control. The valves were examined in gross observation and micro-CT scan and then the leaflets were processed for histology and analyzed in scanning electron microscopy, light microscopy and transmission electron microscopy. RESULT Crimping of the valves resulted in the increase thickness of the leaflets and there was no evidence of additional delamination. The heavy prints of the stents were irregularly distributed on the outflow surface in the crimped devices and were shallow and did not penetrate throughout the thickness of the leaflets. However, the wavy microscopy of collagen fiber bundles was well preserved. They were found to remain individualized without any agglutination as shown by the regular banding appearance. CONCLUSION Crimping of self-deployable valves per se caused only minor damages to the leaflets. However, the procedure could be refined in order to minimize areas of high pressure and swelling of the tissue that can be accompanied with flow surface disruption and increase of the hydraulic conductance. The incorporation of a polyester buffer serves to prevent the deleterious effects that may be caused if the pericardium tissue were in direct contact with the nitinol stent.
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Affiliation(s)
- R Guidoin
- Department of surgery, faculty of medicine, Laval university and axe médecine régénérative, centre de recherche, CHU, Vandry building, 2325, rue de l'Université, GIV OA6 Québec, Canada.
| | - R Zegdi
- Services de chirurgie cardiovasculaire et de pathologie, hôpital européen Georges-Pompidou, 75015 Paris, France
| | - J Lin
- Key laboratory of textile science and technology of Ministry of Education and College of Textile, Donghua university, Shanghai, China
| | - J Mao
- Department of surgery, faculty of medicine, Laval university and axe médecine régénérative, centre de recherche, CHU, Vandry building, 2325, rue de l'Université, GIV OA6 Québec, Canada
| | - O Rochette-Drouin
- Department of surgery, faculty of medicine, Laval university and axe médecine régénérative, centre de recherche, CHU, Vandry building, 2325, rue de l'Université, GIV OA6 Québec, Canada
| | - D How
- Peninsula school of medicine and dentistry, Plymouth, Devon, United Kingdom
| | - X Guan
- Key laboratory of textile science and technology of Ministry of Education and College of Textile, Donghua university, Shanghai, China
| | - P Bruneval
- Services de chirurgie cardiovasculaire et de pathologie, hôpital européen Georges-Pompidou, 75015 Paris, France
| | - L Wang
- Key laboratory of textile science and technology of Ministry of Education and College of Textile, Donghua university, Shanghai, China
| | - L Germain
- Department of surgery, faculty of medicine, Laval university and axe médecine régénérative, centre de recherche, CHU, Vandry building, 2325, rue de l'Université, GIV OA6 Québec, Canada
| | - Z Zhang
- Department of surgery, faculty of medicine, Laval university and axe médecine régénérative, centre de recherche, CHU, Vandry building, 2325, rue de l'Université, GIV OA6 Québec, Canada
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Jalal Z, Galmiche L, Beloin C, Boudjemline Y. Impact of percutaneous pulmonary valve implantation procedural steps on leaflets histology and mechanical behaviour: An in vitro study. Arch Cardiovasc Dis 2016; 109:465-75. [PMID: 27346323 DOI: 10.1016/j.acvd.2016.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Percutaneous pulmonary valve implantation (PPVI) using the bovine jugular vein Melody(®) valve (Medtronic Inc., Minneapolis, MN, USA) is safe and effective. However, post-procedural complications have been reported, the reasons for which are unclear. OBJECTIVE To assess the impact of PPVI procedural steps on valvular histology and leaflet mechanical behaviour. METHODS Three different valved stents (the Melody(®) valve and two homemade stents with bovine and porcine pericardium) were tested in vitro under four conditions: (1) control group; (2) crimping; (3) crimping plus inflation of low-pressure balloon; (4) condition III plus post-dilatation (high-pressure balloon). For each condition, valvular leaflets (and a venous wall sample for Melody(®) stents) were taken for histological analysis and mechanical uniaxial testing of the valve leaflets. RESULTS Among the Melody(®) valves, the incidence of transverse fractures was significantly higher in traumatized samples compared with the control group (P<0.05), whereas the incidence and depth of transverse fractures were not statistically different between the four conditions for bovine and porcine pericardial leaflets. No significant modification of the mechanical behaviour of in vitro traumatized Melody(®) valvular leaflets was observed. Bovine and porcine pericardia became more elastic and less resilient after balloon expansion and post-dilatation (conditions III and IV), with a significant decrease in elastic modulus and stress at rupture. CONCLUSION Valved stent implantation procedural steps induced histological lesions on Melody(®) valve leaflets. Conversely, bovine and porcine pericardial valved stents were not histologically altered by in vitro manipulations, although their mechanical properties were significantly modified. These data could explain some of the long-term complications observed with these substitutes.
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Affiliation(s)
- Zakaria Jalal
- Centre de référence malformations cardiaques congénitales complexes, M3C, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, paediatric cardiology, 149, rue de Sèvres, 75015 Paris cedex, France
| | - Louise Galmiche
- Hôpital Necker-Enfants-Malades, laboratoire d'anatomopathologie, 75015 Paris, France
| | - Christophe Beloin
- Unité de génétique des biofilms, département de microbiologie, institut Pasteur, 75015 Paris, France
| | - Younes Boudjemline
- Centre de référence malformations cardiaques congénitales complexes, M3C, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, paediatric cardiology, 149, rue de Sèvres, 75015 Paris cedex, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.
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20
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Sheriff J, Claiborne TE, Tran PL, Kothadia R, George S, Kato YP, Pinchuk L, Slepian MJ, Bluestein D. Physical Characterization and Platelet Interactions under Shear Flows of a Novel Thermoset Polyisobutylene-based Co-polymer. ACS APPLIED MATERIALS & INTERFACES 2015; 7:22058-22066. [PMID: 26398588 PMCID: PMC4608843 DOI: 10.1021/acsami.5b07254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Over the years, several polymers have been developed for use in prosthetic heart valves as alternatives to xenografts. However, most of these materials are beset with a variety of issues, including low material strength, biodegradation, high dynamic creep, calcification, and poor hemocompatibility. We studied the mechanical, surface, and flow-mediated thrombogenic response of poly(styrene-coblock-4-vinylbenzocyclobutene)-polyisobutylene-poly(styrene-coblock-4-vinylbenzocylcobutene) (xSIBS), a thermoset version of the thermoplastic elastomeric polyolefin poly(styrene-block-isobutylene-block-styrene) (SIBS), which has been shown to be resistant to in vivo hydrolysis, oxidation, and enzymolysis. Uniaxial tensile testing yielded an ultimate tensile strength of 35 MPa, 24.5 times greater than that of SIBS. Surface analysis yielded a mean contact angle of 82.05° and surface roughness of 144 nm, which was greater than for poly(ε-caprolactone) (PCL) and poly(methyl methacrylate) (PMMA). However, the change in platelet activation state, a predictor of thrombogenicity, was not significantly different from PCL and PMMA after fluid exposure to 1 dyn/cm(2) and 20 dyn/cm(2). In addition, the number of adherent platelets after 10 dyn/cm(2) flow exposure was on the same order of magnitude as PCL and PMMA. The mechanical strength and low thrombogenicity of xSIBS therefore suggest it as a viable polymeric substrate for fabrication of prosthetic heart valves and other cardiovascular devices.
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Affiliation(s)
- Jawaad Sheriff
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-8151, USA
| | - Thomas E. Claiborne
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-8151, USA
| | - Phat L. Tran
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
| | - Roshni Kothadia
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-8151, USA
| | - Sheela George
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-8151, USA
| | | | | | - Marvin J. Slepian
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-8151, USA
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
- Sarver Heart Center, University of Arizona, Tucson, AZ 85721, USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-8151, USA
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Kheradvar A, Groves EM, Tseng E. Proof of concept of FOLDAVALVE, a novel 14 Fr totally repositionable and retrievable transcatheter aortic valve. EUROINTERVENTION 2015; 11:591-6. [DOI: 10.4244/eijy15m03_04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Kheradvar A, Groves EM, Goergen CJ, Alavi SH, Tranquillo R, Simmons CA, Dasi LP, Grande-Allen KJ, Mofrad MRK, Falahatpisheh A, Griffith B, Baaijens F, Little SH, Canic S. Emerging Trends in Heart Valve Engineering: Part II. Novel and Standard Technologies for Aortic Valve Replacement. Ann Biomed Eng 2014; 43:844-57. [DOI: 10.1007/s10439-014-1191-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
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23
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The Effects of Transcatheter Valve Crimping on Pericardial Leaflets. Ann Thorac Surg 2014; 97:1260-6. [DOI: 10.1016/j.athoracsur.2013.11.009] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 10/07/2013] [Accepted: 11/08/2013] [Indexed: 11/19/2022]
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Claiborne TE, Slepian MJ, Hossainy S, Bluestein D. Polymeric trileaflet prosthetic heart valves: evolution and path to clinical reality. Expert Rev Med Devices 2013; 9:577-94. [PMID: 23249154 DOI: 10.1586/erd.12.51] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Present prosthetic heart valves, while hemodynamically effective, remain limited by progressive structural deterioration of tissue valves or the burden of chronic anticoagulation for mechanical valves. An idealized valve prosthesis would eliminate these limitations. Polymeric heart valves (PHVs), fabricated from advanced polymeric materials, offer the potential of durability and hemocompatibility. Unfortunately, the clinical realization of PHVs to date has been hampered by findings of in vivo calcification, degradation and thrombosis. Here, the authors review the evolution of PHVs, evaluate the state of the art of this technology and propose a pathway towards clinical reality. In particular, the authors discuss the development of a novel aortic PHV that may be deployed via transcatheter implantation, as well as its optimization via device thrombogenicity emulation.
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Affiliation(s)
- Thomas E Claiborne
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
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25
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Claiborne TE, Sheriff J, Kuetting M, Steinseifer U, Slepian MJ, Bluestein D. In vitro evaluation of a novel hemodynamically optimized trileaflet polymeric prosthetic heart valve. J Biomech Eng 2013; 135:021021. [PMID: 23445066 DOI: 10.1115/1.4023235] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Calcific aortic valve disease is the most common and life threatening form of valvular heart disease, characterized by stenosis and regurgitation, which is currently treated at the symptomatic end-stages via open-heart surgical replacement of the diseased valve with, typically, either a xenograft tissue valve or a pyrolytic carbon mechanical heart valve. These options offer the clinician a choice between structural valve deterioration and chronic anticoagulant therapy, respectively, effectively replacing one disease with another. Polymeric prosthetic heart valves (PHV) offer the promise of reducing or eliminating these complications, and they may be better suited for the new transcatheter aortic valve replacement (TAVR) procedure, which currently utilizes tissue valves. New evidence indicates that the latter may incur damage during implantation. Polymer PHVs may also be incorporated into pulsatile circulatory support devices such as total artificial heart and ventricular assist devices that currently employ mechanical PHVs. Development of polymer PHVs, however, has been slow due to the lack of sufficiently durable and biocompatible polymers. We have designed a new trileaflet polymer PHV for surgical implantation employing a novel polymer-xSIBS-that offers superior bio-stability and durability. The design of this polymer PHV was optimized for reduced stresses, improved hemodynamic performance, and reduced thrombogenicity using our device thrombogenicity emulation (DTE) methodology, the results of which have been published separately. Here we present our new design, prototype fabrication methods, hydrodynamics performance testing, and platelet activation measurements performed in the optimized valve prototype and compare it to the performance of a gold standard tissue valve. The hydrodynamic performance of the two valves was comparable in all measures, with a certain advantage to our valve during regurgitation. There was no significant difference between the platelet activation rates of our polymer valve and the tissue valve, indicating that similar to the latter, its recipients may not require anticoagulation. This work proves the feasibility of our optimized polymer PHV design and brings polymeric valves closer to clinical viability.
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Affiliation(s)
- Thomas E Claiborne
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
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Claiborne TE, Xenos M, Sheriff J, Chiu WC, Soares J, Alemu Y, Gupta S, Judex S, Slepian MJ, Bluestein D. Toward optimization of a novel trileaflet polymeric prosthetic heart valve via device thrombogenicity emulation. ASAIO J 2013; 59:275-83. [PMID: 23644615 PMCID: PMC3648888 DOI: 10.1097/mat.0b013e31828e4d80] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aortic stenosis is the most prevalent and life-threatening form of valvular heart disease. It is primarily treated via open-heart surgical valve replacement with either a tissue or a mechanical prosthetic heart valve (PHV), each prone to degradation and thrombosis, respectively. Polymeric PHVs may be optimized to eliminate these complications, and they may be more suitable for the new transcatheter aortic valve replacement procedure and in devices like the total artificial heart. However, the development of polymer PHVs has been hampered by persistent in vivo calcification, degradation, and thrombosis. To address these issues, we have developed a novel surgically implantable polymer PHV composed of a new thermoset polyolefin called cross-linked poly(styrene-block-isobutylene-block-styrene), or xSIBS, in which key parameters were optimized for superior functionality via our device thrombogenicity emulation methodology. In this parametric study, we compared our homogeneous optimized polcymer PHV to a prior composite polymer PHV and to a benchmark tissue valve. Our results show significantly improved hemodynamics and reduced thrombogenicity in the optimized polymer PHV compared to the other valves. These results indicate that our new design may not require anticoagulants and may be more durable than its predecessor, and validate the improvement, toward optimization, of this novel polymeric PHV design.
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Affiliation(s)
| | | | - Jawaad Sheriff
- Dept. of Biomedical Engineering, Stony Brook University, Stony Brook, NY
| | - Wei-Che Chiu
- Dept. of Biomedical Engineering, Stony Brook University, Stony Brook, NY
| | - Joao Soares
- Dept. of Biomedical Engineering, Stony Brook University, Stony Brook, NY
| | - Yared Alemu
- Dept. of Biomedical Engineering, Stony Brook University, Stony Brook, NY
| | - Shikha Gupta
- Dept. of Biomedical Engineering, Stony Brook University, Stony Brook, NY
| | - Stefan Judex
- Dept. of Biomedical Engineering, Stony Brook University, Stony Brook, NY
| | - Marvin J. Slepian
- Dept. of Biomedical Engineering, Stony Brook University, Stony Brook, NY
- Department of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ
| | - Danny Bluestein
- Dept. of Biomedical Engineering, Stony Brook University, Stony Brook, NY
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Convelbo C, Guetat P, Cambillau M, Allam B, Bruneval P, Lafont A, Zegdi R. Crimping and deployment of balloon-expandable valved stents are responsible for the increase in the hydraulic conductance of leaflets. Eur J Cardiothorac Surg 2013; 44:1045-50. [DOI: 10.1093/ejcts/ezt175] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tseng EE, Wisneski A, Azadani AN, Ge L. Engineering perspective on transcatheter aortic valve implantation. Interv Cardiol 2013. [DOI: 10.2217/ica.12.73] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Amahzoune B, Bruneval P, Allam B, Lafont A, Fabiani JN, Zegdi R. Traumatic leaflet injury during the use of percutaneous valves: a comparative study of balloon- and self-expandable valved stents. Eur J Cardiothorac Surg 2012; 43:488-93. [DOI: 10.1093/ejcts/ezs359] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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