Posts Tagged ‘percutaneous aortic valve implantation’

Welcome to the  future of  valvular heart disease . This is just the beginning.Expect more dramatic break through  . (Already mitral valve prototype is in advanced stages of development .)

Currently we have two approved percutaneous aortic valves for use in isolated Aortic stenosis. The Edwards valve is popular in  USA  ( 2011 ) and Medtronic  is used extensively in  Europe (From 2007)

Though both valves appear suitable .There are major differences in the concept , design , and technique of implantation .

tavi edward sapiens vs medtronic core valve


Major  issues to be addressed. Late onset Para valvular leak :
Please remember, these valves are not sutured around the aortic annulus ,  which our surgeons do it meticulously . The force that keep the valve  within the  aortic root is nothing but the disease process itself . The stiffened, elastic aortic root .(Does it appear  foolish to expect the diseased  aorta to hold the valve in situ ? but that is the reality  ! )
If the aortic root  dilates  for  some reason  which is very likely in  atherosclerotic  process    the very foundation of valve is shaken and para valvular leak is certain.

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Trans catheter  aortic valve implantation(TAVI )  is gaining acceptance  as an alternative to surgical aortic valve replacement  .It has successfully negotiated the  initial hurdles and entered the clinical domain . More and more patients receive this modality as the expertise and hardware show consistent  improvement.

Although  TAVI  is   limited to patients in high risk category for surgery , it is expected to make in roads into  intermediate  risk patients  as well  and pose a  real threat to cardiac surgeons  in the years to come .

The only  point surgeons  can rejoice is ,  it cannot be  implanted in patients with aortic regurgitation  as of now.

This video is posted  free by NEJM ,  is stunningly clear in conveying concept of TAVI !

Thank you NEJM .

And this one from  Siemens  seems to  beat the NEJM .

And  now a Hybrid  imaging  creates a virtual aorta in the  cath lab

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