Methodist DeBakey Cardiovascular Journal Vol. 8, No. 2
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چکیده
Transcatheter aortic valve implantation (TAVI) has proven to be a viable alternative for patients with symptomatic severe aortic stenosis who are at high risk for surgical aortic valve replacement. At the same time, there is increasing evidence that moderateto-severe periprosthetic aortic regurgitation after TAVI is associated with dramatically increased mortality and morbidity. The issue of proper positioning of the valve, including the ability to reposition and recapture the device, must be dealt with before the use of TAVI can be extended to younger, healthier patients. The next generation of transcatheter heart valves will most likely address repositionability to facilitate accurate placement with additional features that minimize paravalvular leakage. Upcoming devices promise to improve outcomes and usability of current TAVI systems. Figure 1. Sadra Medical LotusTM aortic valve. Courtesy of Sadra Medical, Inc./Boston Scientific, Natick, Massachusetts. tissue valve mounted on a braided nitinol stent structure that expands in the native annulus as it shortens (the “Chinese finger trap” principle). this deployment procedure enables a more flexible delivery system, provides radial strength, and makes repositioning or recapturing of the device possible at any time prior to release. the accurate placement of the valve is facilitated by a radiopaque center marker that allows alignment with the native valve. the preloaded prosthesis is positioned over a threearmed, self-centering system (Figure 1). an additional so-called “adaptive seal” at the lower part of the prosthesis skirt helps to conform to irregular surfaces of the native anatomy and to further reduce periprosthetic ar. the sadra lotus system is delivered percutaneously over an 18-Fr introducer sheath. in 2011, the rePrise Ce Mark trial with two valve sizes, 23 mm and 27 mm, was initiated in Germany, France, the united kingdom, and australia. Direct Flow Medical Aortic Valve the direct Flow Medical aortic valve (direct Flow Medical, santa rosa, California) consists of a bovine pericardial tissue valve that is mounted between two inflatable polyester rings
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