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Archive for the ‘Hadwares in cardiology’ Category

The concept of TAVR(Trancutaneous aortic valve replacement ) is trying hard  to prevail over surgical aortic valve replacement .Two companies Medtronic and Edwards life have their products (Core and Sapiens)  tested and used with varying success.Meanwhile, Boston scientific has come out with a new one , Lotus valve made with stainless steel and bovine pericardium.

 

lotus valve tavr

Lotus valve  seems to have a distinct  advantage* (over the Core and Sapiens ) in terms of easy delivery and adjustment (or retrieval ) of valve till  final position and efficient adoptive steel technology in preventing para-valvular leak.

* Outcome awaited.

Human  trials has started with lotus valve in USA 2014.The REPRISE III trial would compare  one to one Lotus vs core valve . Results will be out by 2017.Unlike many interventions the utility value and long-term outcome of  TAVR  seem to be genuine and patients  waiting for aortic valve surgery can look forward to this as a genuine non surgical alternative.

Responding to this , Medtronic and Edwards are  improving upon core valve with Evolute R /Engager and SAPIEN3 , expected  to give a tough time for LOTUS.

Reference

1.RESPOND registry , REPRISE 1, 2 and 3 trials

2.A review article on TAVR 

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Preamble * This article is meant  specifically  for cardiac professionals only .There has been so many queries to me about this device Megavac from patients  and public. It is  just another tool for assisting angioplasty in very special situations . Successful angioplasty can be performed without the need for such devices 9 out of 10 times.  I request the non medical readers to skip this article and follow your cardiologist’s advice  and don’t get unduly  anxious.

Dr Venkatesan .Chennai.India

If thrombus is the chief culprit in any vascular emergency  there can be  no second thoughts as it needs immediate  arrest without warrant! (STEMI,Acute pulmonary embolism , DVT, Acute limb ischemia etc) Since pharmacological lysis of thrombus is easy and  be done immediately  it will continue to play a major role still , in many clinical situations that critically compromise organ function .

However , large  thrombus burden  (or in which medical therapy fails to do a good job )  we must  intervene mechanically  to change the course of event.Though vascular surgery is a definitive option its always better we try out catheter based thrombectomy.

Many hardwares are being developed in the recent times. Aspiration catheters, baskets etc * .This  one from vascular capture (Minnesota USA)  appear promising as its a universal capture device that can be  used anywhere coronary , pulmonary or even in deep veins .

Clinical case examples using megavac : Video

*Few  examples of Thrombectomy devices.

1.They can be mechanical rotational devices like Amplatz Thrombectomy Device (ATD) Microvena,  Straub Rotarex (Straub Medical, Wangs, Switzerland) and the Tretorotola Device ( Arrow International, USA) employ a high-velocity rotating helix or nitinol cage that macerates the  thrombus.Disadvantage is endothelial contact with moving mechanical parts.

2.The Angiojet device (Angiojet; Possis, Minneapolis, USA) uses a rheolytic mechanism with possible   less endothelial injury as there is no true contact with endothelium.

3.Ultrasound mediated lyis ( EKOS Endowave (EKOS Corporation, USA) and Omniwave (Omnisonics Medical Technologies,  USA)  fragment with high frequency ultrasonic waves.

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