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Review
. 2016 Dec 30;2016(4):e201632.
doi: 10.21542/gcsp.2016.32.

The development of transcatheter aortic valve replacement (TAVR)

Alain Cribier  1
Affiliations
Review

The development of transcatheter aortic valve replacement (TAVR)

Alain Cribier. Glob Cardiol Sci Pract. .
No abstract available

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Rational for developing interventional technologies for severe AS: An Unmet Clinical Need.
Figure 2.
Figure 2.. Birth of the idea of “stented-valve” in AS.
Left panel: A stent crimped over a high-pressure valvuloplasty balloon might keep the valve open and prevent restenosis. A valve structure should be added within the stent. Right panel: Validation of the concept of intra-valvular stenting and optimal height of the frame to respect adjoining structures.
Figure 3.
Figure 3.. 1994: Drawings and model prefiguring a balloon expandable transcatheter bioprosthesis.
A: specific stent frame design allowing to attach a tricuspid valvular structure. Partial external coverage would limit the risk of aortic regurgitation through the struts. B: Hand made model of stented-valve before and after crimping over a balloon catheter (external diameter: 8 mm). C: Drawing of the different phases of transcatheter aortic valve implantation.
Figure 4.
Figure 4.. The translational pathway of transcatheter aortic valve replacement: driving for superior outcomes.
Figure 5.
Figure 5.. New testing equipment designed by PVT for the evaluation of valve structure and frame.
Figure 6.
Figure 6.. A: Various prototypes and finalized device (B) created by PVT.
C: Crimped device over a 23 mm Numed balloon catheter, and 24F introducer for implantation in the sheep model. Angiographic evaluation post-implantation within the native aortic valve, and transesophageal echocardiography evaluation of valvular function.
Figure 7.
Figure 7.. First-in-Man implantation (Rouen, April 16th, 2002).
A—The complex antegrade transseptal route used for TAVR. B—View of the transcatheter valve in place within the native calcified valve and hemodynamic result (no gradient). C—The patient immediately after valve implantation and D, 8 days later.
Figure 8.
Figure 8.. Edwards Lifesciences input after acquisition of Percutaneous Valve Technologies (2004): development of the SAPIEN valve and of new approaches for TAVR: transfemoral retrograde and transapical antegrade.
Figure 9.
Figure 9.. Advanced valve and delivery systems have changed the world of TAVI overtime.
Several generations of Edwards and Medtronic CoreValve led to decreased crimped sizes and launch additional valve sizes for a better coverage of the aortic annulus.
Figure 10.
Figure 10.. New models of bioprosthesis approved in Europe.
Figure 11.
Figure 11.. The different phases of transfemoral TAVI using the “minimalist” approach (SAPIEN 3 implantation).
Figure 12.
Figure 12.. Development of the balloon expandable valve: an ongoing odyssey.
See this image and copyright information in PMC

References

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    1. Lindroos M, Kupari M, Heikkilä J, et al. Epidemiological studies estimate the prevalence of aortic stenosis at 5% in subjects over the age of 75 years. J Am Coll Cardiol. 1993;21:1220–5. - PubMed
    1. Ross Jr J, Braunwald E. Aortic stenosis. Circulation. 1968;38:61–7. - PubMed
    1. Edwards FH, Peterson ED, Coombs LP, et al. Prediction of operative mortality after valve replacement surgery. J Am Coll Cardiol. 2001;37:885–9. - PubMed
    1. Society of Thoracic Surgeons: STS national database: STS U.S. Cardiac Surgery Database: 1997 Aortic valve replacement patients: Preoperative risk variables. Chicago: Society of Thoracic Surgeons, 2000. Available at http://www.ctsnet.org/doc/3031.2000 .