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Jaworek M, Gelpi G, Perico F, Romagnoni C, Tasca G, Salurso E, Contino M, Redaelli A, Fiore GB, Vismara R. Coronary Perfusion After Valve-in-Valve Transcatheter Aortic Valve Implantation in Small Aortic Root: In Vitro Experimental Assessment. J Cardiovasc Transl Res 2023; 16:956-967. [PMID: 37097591 PMCID: PMC10480284 DOI: 10.1007/s12265-023-10364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/13/2023] [Indexed: 04/26/2023]
Abstract
Coronary flow obstruction following transcatheter aortic valve-in-valve implantation (VIV-TAVI) is associated with a high mortality risk. The aim of this work was to quantify the coronary perfusion after VIV-TAVI in a high-risk aortic root anatomy. 3D printed models of small aortic root were used to simulate the implantation of a TAVI prosthesis (Portico 23) into surgical prostheses (Trifecta 19 and 21). The aortic root models were tested in a pulsatile in vitro bench setup with a coronary perfusion simulator. The tests were performed at baseline and post-VIV-TAVI procedure in aligned and misaligned commissural configurations under simulated hemodynamic rest and exercise conditions. The experimental design provided highly controllable and repeatable flow and pressure conditions. The left and right coronary mean flow did not differ significantly at pre- and post-VIV-TAVI procedure in any tested configurations. The commissural misalignment did not induce any significant alterations to the coronary flow. High-risk aortic root anatomy did not trigger coronary ostia obstruction or coronary flow alteration after transcatheter aortic valve implantation in a surgical bioprosthesis as shown from in-vitro flow loop tests.
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Affiliation(s)
- Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Guido Gelpi
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Perico
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Claudia Romagnoni
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Giordano Tasca
- Cardiac Surgery Department, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Eleonora Salurso
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Monica Contino
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Gianfranco Beniamino Fiore
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
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Steblovnik K, Bunc M. Technical Aspects and Development of Transcatheter Aortic Valve Implantation. J Cardiovasc Dev Dis 2022; 9:jcdd9080282. [PMID: 36005446 PMCID: PMC9409777 DOI: 10.3390/jcdd9080282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Aortic stenosis is the most common valve disease requiring surgery or percutaneous treatment. Since the first-in-man implantation in 2002 we have witnessed incredible progress in transcatheter aortic valve implantation (TAVI). In this article, we review the technical aspects of TAVI development with a look at the future. Durability, low thrombogenicity, good hydrodynamics, biocompatibility, low catheter profile, and deployment stability are the attributes of an ideal TAVI device. Two main design types exist-balloon-expandable and self-expanding prostheses. Balloon-expandable prostheses use a cobalt-chromium alloy frame providing high radial strength and radiopacity, while the self-expanding prostheses use a nickel-titanium (Nitinol) alloy frame, which expands to its original shape once unsheathed and heated to the body temperature. The valve is sewn onto the frame and consists of the porcine or bovine pericardium, which is specially treated to prevent calcinations and prolong durability. The lower part of the frame can be covered by polyethylene terephthalate fabric or a pericardial skirt, providing better sealing between the frame and aortic annulus. The main future challenges lie in achieving lower rates of paravalvular leaks and new pacemaker implantations following the procedure, lower delivery system profiles, more precise positioning, longer durability, and a good hemodynamic profile. Patient-specific design and the use of autologous tissue might solve these issues.
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