The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Preclinical evaluation of a transcatheter aortic valve replacement system for patients with rheumatic heart disease.

DOI: 10.4244/EIJ-D-18-01052

1. Christiaan Barnard Division of Cardiothoracic Surgery, University of Cape Town, South Africa, South Africa
2. Christiaan Barnard Division of Cardiothoracic Surgery, University of Cape Town, South Africa
3. Department of Anaesthesia and Perioperative Medicine, University of Cape Town, South Africa
4. Department of Anaesthesia and Perioperative Medicine, University of Cape Town, South Africa
5. S.A.T., University of Cape Town, South Africa
6. S.A.T., University of Cape Town, South Africa
7. Christiaan Barnard Division of Cardiothoracic Surgery, University of Cape Town, South Africa; Cardiovascular Research Unit, University of Cape Town, South Africa
8. S.A.T., University of Cape Town, South Africa; Wake Forrest School of Medicine, Winston Salem, USA
9. S.A.T., University of Cape Town, South Africa; Cardiovascular Research Unit, University of Cape Town, South Africa
10. Christiaan Barnard Division of Cardiothoracic Surgery, University of Cape Town, South Africa; S.A.T., University of Cape Town, South Africa; Cardiovascular Research Unit, University of Cape Town, South Africa
Disclaimer:

As a public service to our readership, this article - peer reviewed by the Editors of EuroIntervention - has been published immediately upon acceptance as it was received. The content of this article is the sole responsibility of the authors, and not that of the journal or its publishers.

To read the full content of this article, please log in to download the PDF.

Aims: Cardiac surgery in middle-income countries differs significantly from that in high-income countries regarding prevailing heart valve pathologies and access to cardiac surgery. Typically, rheumatic aortic regurgitation in the absence of calcification by far outweighs stenosis. As such entirely different trans-catheter aortic valve (TAVI) concepts are required for these regions. 

Methods and results: A self-homing, non-occlusive balloon-expandable TAVI system comprising a hollow-balloon, stabilizing locator-trunks, a scalloped CoCr-stent with elevating anchorage-arms and decellularized, sandwich-crosslinked pericardium was compared with control surgical valves (Edwards Perimount) in sheep. The implantation period was five months. The tactile placement of the TAVI valves was accomplished without the need for rapid pacing. At termination, no structural degeneration was observed in either groups. TAVIs were well-healed with the stent-struts largely embedded in tissue. Correlating with sheep-growth (weight gain of 40.4±13.0%) during the implantation period, mean transvalvular gradients increased from 3.08±1.95mmHg to 8.50±5.38mmHg (p=0.044) after 5 months. 

Conclusions: A single-stage, balloon-expandable, easy-to-place TAVI system with antigen-depleted and antigen-masked bioprosthetic leaflets promises to address the distinct needs of low and middle-income countries in regard to TAVI better than conventional systems.

Sign in to read and download the full article

Forgot your password?
No account yet? Sign up for free!
Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Read next article

Dual antiplatelet therapy after percutaneous coronary intervention: entering the final chapter?