Interventions for valvular disease and heart failure

Early safety and feasibility of a first-in-class biomimetic transcatheter aortic valve - DurAVR

EuroIntervention 2023;19:e352-e362. DOI: 10.4244/EIJ-D-23-00282

Susheel  K. Kodali
Susheel K. Kodali1, MD; Paul Sorajja2, MD; Christopher U. Meduri3, MD; Kari Feldt3,4, MD; João L. Cavalcante2, MD; Pankaj Garg5,6, MD, PhD; Nadira Hamid2, MD; Karl K. Poon7, MD; Magnus R.M. Settergren3,4, MD, PhD; Marcus R. Burns2, DNP; Andreas Rück3,4, MD; Janarthanan Sathananthan8, MD; Alan Zajarias9, MD; Tamaz Shaburishvili10, MD; Teona Zirakashvili10, MD; Maia Zhividze10, MD; George Katchakhidze11, MD; Vinayak N. Bapat2, MBBS, MS, MCh, FRCS (Ed), FCRS (CTh)
1. Columbia University Irving Medical Center, New York, NY, USA; 2. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; 3. Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; 4. Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; 5. Norwich Medical School, University of East Anglia, Norwich, UK; 6. Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK; 7. St. Andrew’s War Memorial Hospital, Brisbane, QLD, Australia; 8. St. Paul’s Hospital, Vancouver, BC, Canada; 9. Washington University School of Medicine, St. Louis, MO, USA; 10. Cardiovascular Clinic, Tbilisi Heart and Vascular Clinic, Tbilisi, Georgia; 11. Aversi Clinic, Tbilisi, Georgia

Background: TAVI is a widely accepted treatment for patients with severe aortic stenosis (AS). Despite the adoption of diverse therapies, opportunities remain to develop technologies tailored to provide optimal acute and potential long-term benefits, particularly around haemodynamics, flow and durability.

Aims: We aimed to evaluate the safety and feasibility of the DurAVR transcatheter heart valve (THV), a first-in-class biomimetic valve, in the treatment of patients with symptomatic severe AS.

Methods: This was a first-in-human (FIH), prospective, non-randomised, single-arm, single-centre study. Patients with severe, symptomatic AS of any surgical risk and who were eligible for the DurAVR THV prosthesis were recruited; they were assessed at baseline, 30 days, 6 months, and 1 year post-procedure for implant success, haemodynamic performance, and safety.

Results: Thirteen patients (73.9±6.4 years old, 77% female) were enrolled. The DurAVR THV was successfully implanted in 100% of cases with no device-related complications. One access site complication, one permanent pacemaker implantation, and one case of moderate aortic regurgitation occurred. Otherwise, no deaths, stroke, bleeding, reinterventions, or myocardial infarction were reported during any of the follow-up visits. Despite a mean annulus size of 22.95±1.09 mm, favourable haemodynamic results were observed at 30 days (effective orifice area [EOA] 2.00±0.17 cm2, and mean pressure gradient [MPG] 9.02±2.68 mmHg) and were sustained at 1 year (EOA 1.96±0.11 cm2, MPG 8.82±1.38 mmHg), resulting in zero patients with any degree of prosthesis-patient mismatch. Additionally, new valve performance measures derived from cardiovascular magnetic resonance displayed restoration of laminar flow, consistent with a predisease state, in conjunction with a mean coaptation length of 8.3±1.7 mm.

Conclusions: Preliminary results from the FIH study with DurAVR THV demonstrate a good safety profile with promising haemodynamic performance sustained at 1 year and restoration of near-normal flow dynamics. Further clinical investigation is warranted to evaluate how DurAVR THV may play a role in addressing the challenge of lifetime management in AS patients.

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