Percutaneous aortic valve replacement

Percutaneous aortic valve replacement
Intervention
ICD-9-CM	35.21-35.22, 35.96

In Percutaneous aortic valve replacement or Transcatheter Aortic Valve Implantation (TAVI), a replacement valve is passed through a hole in the groin by a puncture of the femoral artery and advanced up to the ascending aorta of the patient. It substitutes for a more invasive procedure in which the chest is opened. The survival is equivalent, but the risk of stroke is higher.

The catheter procedure was developed in Europe, initially performed in 2002. It is effective in improving functioning in the patients with severe aortic stenosis. It is still in clinical trial testing in the United States, and has not been approved by the FDA.

In high-risk patients with severe aortic stenosis, transcatheter and surgical procedures for aortic-valve replacement had similar rates of survival at 1 year, although there were important differences in risks associated with the procedure.^[1] The transcatheter procedure was associated with a higher risk of stroke than the surgical replacement (5.5% vs. 2.4% after 30 days; 8.3% vs. 4.3% after 1 year).^[2]

In 2010 good results (20% better 1 year survival) were reported from a US trial on 358 patients.^[3] The procedure was called transcatheter aortic-valve implantation (TAVI) and implanted cow heart valves.

Devices

There are two current market leaders whose devices have earned CE Mark approval in Europe and are available to physicians for implantation in appropriate patients; the CoreValve device (a self-expanding valve prosthesis consisting of a Nickel-titanium frame with a tri-leaflet valve fashioned out of porcine pericardium mounted within) and the SAPIEN device by Edwards Lifesciences (a balloon-expandable tubular metal stent with a tri-leaflet valve fashioned out of bovine percardium mounted within).

References

1. ^ Smith, Craig R.; et al. (June 2, 2011). "Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients". N Engl J Med 364: 2187–2198. doi:10.1056/NEJMoa1103510. http://www.nejm.org/doi/full/10.1056/NEJMoa1103510. 
2. ^ Schaff, Hartzell V. (June 2, 2011). "Transcatheter Aortic-Valve Implantation — At What Price?". N Engl J Med 364: 2256–2258. doi:10.1056/NEJMe1103978. http://www.nejm.org/doi/full/10.1056/NEJMe1103978. 
3. ^ "New Procedure for Aortic Valve Replacement Looks Promising". 22 Sept 2010. http://www.nlm.nih.gov/medlineplus/news/fullstory_103606.html. 

“Novel stent design for Percutaneous aortic valve replacement” - G.V.P Kumar & L.Mathew, IFMBE Proceedings, Springerlink,4th Kuala Lumpur International Conference on Biomedical Engineering 25–28 June 2008, Pages 446-448.

“Design for Percutaneous Aortic Valve Stent” – Gideon PraveenKumar & Dr.Lazar Mathew, International Conference on Biotechnology Proceedings, VIT University, Feb 8th 2008, Pages 139-140

“New Stent Design for Percutaneous Aortic Valve Replacement” - Gideon Praveen Kumar & Lazar Mathew International Journal of Cardiovascular Revascularization Medicine , (2009) , volume 10 , issue 2 , Pages 121 – 124

“Effects of Stent Design Parameters on the Aortic Endothelium" – Gideon Praveen Kumar & Lazar Mathew IFMBE Series, 13th International Conference on Biomedical Engineering, Singapore, 3–6 December 2008, volume 23, Pages 1539–1542

Further reading

• van Herwerden L, Serruys P (2002). "Percutaneous valve implantation: back to the future?". Eur Heart J 23 (18): 1415–6. doi:10.1053/euhj.2002.3305. PMID 12208220. 

• de Jaegere, Peter; Arie Pieter Kappetein; Marco Knook; Ben Ilmer; Dries van der Woerd; Yvon Deryck; Marjo de Ronde; Ricardo Boks; G. Sianos; Jurgen Ligthart; Jean-Claude Laborde; Ad Bogers; Patrick W. Serruys. "Percutaneous aortic valve replacement in a patient who could not undergo surgical treatment. A case report with the CoreValve aortic valve prosthesis.". EuroInterv 2006. pp. 1:475–479. http://www.europcronline.com/eurointervention/4th_issue/79/?ind=1. Retrieved 2006-10-18. 

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