Skip to main content

An Engineering Review of Transcatheter Aortic Valve Technologies

Abstract

Senile aortic stenosis (AS), the narrowing and progressive dysfunction of the valve between the heart and the aorta, is the most common structural heart disease in the elderly, with an estimated increase in prevalence from approximately 38.7 million in 2008 to 88.5 million by 2050. The indications for conventional open aortic valve replacement (AVR) utilizing cardiopulmonary bypass remains the standard of care with excellent results. However, physicians remain reluctant to recommend AVR for elderly patients or those considered very high risk. The advent of transcatheter aortic valve intervention (TAVI, transfemoral, and transapical) represents a tremendous advance in our ability to treat high-risk patients with severe AS. By avoiding the risks associated with aortic cross-clamping and cardiopulmonary bypass, it provides a treatment alternative for patients deemed too high risk for conventional AVR. However, this technology is still in the initial stages of clinical use and thus several design challenges and opportunities for improvements in the engineering concepts exist. This paper reviews the outcomes of the two TAVI technologies currently in wide clinical use, the Edwards Sapien® Valve (ESV) and the Medtronic CoreValve® (MCV) and discusses potential improvements in the current design.

This is a preview of subscription content, access via your institution.

FIGURE 1
FIGURE 2
FIGURE 3
FIGURE 4
FIGURE 5
FIGURE 6

References

  1. 1.

    Asimakopoulos, G., M. B. Edwards, and K. M. Taylor. Aortic valve replacement in patients 80 years of age and older: survival and cause of death based on 1100 cases: collective results from the UK Heart Valve Registry. Circulation 96(10):3403–3408, 1997.

    Google Scholar 

  2. 2.

    Ben-Dor, I., et al. Effects of percutaneous aortic valve replacement on coronary blood flow assessed with transesophageal Doppler echocardiography in patients with severe aortic stenosis. Am. J. Cardiol. 104(6):850–855, 2009.

    Article  Google Scholar 

  3. 3.

    Bloomstein, L. Z., et al. Aortic valve replacement in geriatric patients: determinants of in-hospital mortality. Ann. Thorac. Surg. 71(2):597–600, 2001.

    Article  Google Scholar 

  4. 4.

    Bombien, R., et al. Percutaneous aortic valve replacement: computed tomography scan after valved stent implantation in human cadaver hearts. Eur. J. Cardiothorac. Surg. 36(3):592–594, 2009.

    Article  Google Scholar 

  5. 5.

    Bonow, R. O., et al. ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J. Am. Coll. Cardiol., 48(3):e1–e148, 2006

    Article  Google Scholar 

  6. 6.

    Bramstedt, K. A. Aortic valve replacement in the elderly: frequently indicated yet frequently denied. Gerontology 49(1):46–49, 2003.

    Article  Google Scholar 

  7. 7.

    Clavel, M. A., et al. Severe valvular regurgitation and late prosthesis embolization after percutaneous aortic valve implantation. Ann. Thorac. Surg. 87(2):618–621, 2009.

    Article  Google Scholar 

  8. 8.

    Clavel, M. A., et al. Comparison of the hemodynamic performance of percutaneous and surgical bioprostheses for the treatment of severe aortic stenosis. J. Am. Coll. Cardiol. 53(20):1883–1891, 2009.

    Article  Google Scholar 

  9. 9.

    Cribier, A., et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 106(24):3006–3008, 2002.

    Article  Google Scholar 

  10. 10.

    Dasi, L. P., et al. Fluid mechanics of artificial heart valves. Clin. Exp. Pharmacol. Physiol. 36(2):225–237, 2009.

    Article  Google Scholar 

  11. 11.

    Detaint, D., et al. Determinants of significant paravalvular regurgitation after transcatheter aortic valve: implantation impact of device and annulus discongruence. JACC Cardiovasc. Interv. 2(9):821–827, 2009.

    Article  Google Scholar 

  12. 12.

    Dumont, E., et al. Rapid pacing technique for preventing ventricular tears during transapical aortic valve replacement. J. Card. Surg. 24(3):295–298, 2009.

    Article  MathSciNet  Google Scholar 

  13. 13.

    Filsoufi, F., et al. Excellent early and late outcomes of aortic valve replacement in people aged 80 and older. J. Am. Geriatr. Soc. 56(2):255–261, 2008.

    Article  Google Scholar 

  14. 14.

    Grube, E., R. Mueller, B. Sauren, B. Zickmann, H. Beucher, T. Felderhoff, S. Iversen, et al. Progress and current status of percutaneous aortic valve replacement: results of three device generations of the CoreValve revaluing system. Circ. Cardiovasc. Intervent. 1:167–175, 2008.

    Article  Google Scholar 

  15. 15.

    Grube, E., et al. Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study. Circulation 114(15):1616–1624, 2006.

    Article  Google Scholar 

  16. 16.

    Grube, E., et al. Progress and current status of percutaneous aortic valve replacement: results of three device generations of the CoreValve Revalving system. Circ. Cardiovasc. Interv. 1(3):167–175, 2008.

    Article  Google Scholar 

  17. 17.

    Iung, B., et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur. Heart J. 26(24):2714–2720, 2005.

    Article  Google Scholar 

  18. 18.

    Jilaihawi, H., et al. Predictors for permanent pacemaker requirement after transcatheter aortic valve implantation with the CoreValve bioprosthesis. Am. Heart J. 157(5):860–866, 2009.

    Article  Google Scholar 

  19. 19.

    Lansac, E., et al. A four-dimensional study of the aortic root dynamics. Eur. J. Cardiothorac. Surg. 22(4):497–503, 2002.

    Article  Google Scholar 

  20. 20.

    Lansac, E., et al. Aortic root dynamics are asymmetric. J. Heart Valve Dis. 14(3):400–407, 2005.

    Google Scholar 

  21. 21.

    Lichtenstein, S. V., et al. Transapical transcatheter aortic valve implantation in humans: initial clinical experience. Circulation 114(6):591–596, 2006.

    Article  Google Scholar 

  22. 22.

    Litzler, P. Y., et al. Surgical aortic valve replacement after percutaneous aortic valve implantation: what have we learned? J. Thorac. Cardiovasc. Surg. 136(3):697–701, 2008.

    Article  Google Scholar 

  23. 23.

    Maroto, L. C., et al. Delayed dislocation of a transapically implanted aortic bioprosthesis. Eur. J. Cardiothorac. Surg. 36(5):935–937, 2009.

    Article  Google Scholar 

  24. 24.

    Melby, S. J., et al. Aortic valve replacement in octogenarians: risk factors for early and late mortality. Ann. Thorac. Surg. 83(5):1651–1656, 2007; (discussion 1656–1657).

    Article  Google Scholar 

  25. 25.

    Nkomo, V. T., et al. Burden of valvular heart diseases: a population-based study. Lancet 368(9540):1005–1011, 2006.

    Article  Google Scholar 

  26. 26.

    Piazza, N., et al. Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval. EuroIntervention 4(2):242–249, 2008.

    Google Scholar 

  27. 27.

    Ross, J., Jr. and E. Braunwald. Aortic stenosis. Circulation 38(1 Suppl):61–67, 1968.

    Google Scholar 

  28. 28.

    Schultz, C. J., et al. Geometry and degree of apposition of the CoreValve ReValving system with multislice computed tomography after implantation in patients with aortic stenosis. J. Am. Coll. Cardiol. 54(10):911–918, 2009.

    Article  Google Scholar 

  29. 29.

    Tamburino, C., et al. Procedural success and 30-day clinical outcomes after percutaneous aortic valve replacement using current third-generation self-expanding CoreValve prosthesis. J. Invasive Cardiol. 21(3):93–98, 2009.

    Google Scholar 

  30. 30.

    Thourani, V. H., et al. Long-term outcomes after isolated aortic valve replacement in octogenarians: a modern perspective. Ann. Thorac. Surg. 86(5):1458–1464, 2008; discussion 1464–1465.

    Article  Google Scholar 

  31. 31.

    Thubrikar, M., L. P. Bosher, and S. P. Nolan. The mechanism of opening of the aortic valve. J. Thorac. Cardiovasc. Surg. 77(6):863–870, 1979.

    Google Scholar 

  32. 32.

    Thubrikar, M., et al. Design and dynamic variations of aortic valve leaflets in vivo. Surg. Forum 30:241–243, 1979.

    Google Scholar 

  33. 33.

    Thubrikar, M., et al. The cyclic changes and structure of the base of the aortic valve. Am. Heart J. 99(2):217–224, 1980.

    Article  Google Scholar 

  34. 34.

    Ussia, G. P., et al. Quality of life assessment after percutaneous aortic valve implantation. Eur. Heart J. 30(14):1790–1796, 2009.

    Article  Google Scholar 

  35. 35.

    Walther, T., et al. Transapical minimally invasive aortic valve implantation: multicenter experience. Circulation 116(11 Suppl):I240–I245, 2007.

    Google Scholar 

  36. 36.

    Walther, T., et al. Transapical aortic valve implantation: step by step. Ann. Thorac. Surg. 87(1):276–283, 2009.

    Article  Google Scholar 

  37. 37.

    Webb, J. G., et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation 116(7):755–763, 2007.

    Article  Google Scholar 

  38. 38.

    Wong, D. R., et al. Mitral valve injury late after transcatheter aortic valve implantation. J. Thorac. Cardiovasc. Surg. 137(6):1547–1549, 2009.

    Article  Google Scholar 

  39. 39.

    Yoganathan, A. P., Z. He, and S. Casey Jones. Fluid mechanics of heart valves. Annu. Rev. Biomed. Eng. 6:331–362, 2004.

    Article  Google Scholar 

  40. 40.

    Yoganathan, A. P., et al. Advances in prosthetic heart valves: fluid mechanics of aortic valve designs. J. Biomater. Appl. 2(4):579–614, 1988.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Vinod H. Thourani.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Padala, M., Sarin, E.L., Willis, P. et al. An Engineering Review of Transcatheter Aortic Valve Technologies. Cardiovasc Eng Tech 1, 77–87 (2010). https://doi.org/10.1007/s13239-010-0008-4

Download citation

Keywords

  • Aortic valve
  • Aortic stenosis
  • Transcatheter aortic valve technologies
  • Heart valve hemodynamics