Percutaneous stent-mounted valve for treatment of aortic or pulmonary valve disease.
The objective of this study was to develop a prosthetic cardiac valve designed for percutaneous transcatheter implantation. Percutaneous catheter-based therapies play a limited role in the management of cardiac valve disease. Surgical implantation of prosthetic valves usually requires thoracotomy and cardiopulmonary bypass. The stent-valve is constructed of a rolled sheet of heat-treated nitinol. Although malleable when cooled, once released from a restraining sheath at body temperature the stent unrolls, becomes rigid, and assumes its predetermined cylindrical conformation. A ratcheting lock-out mechanism prevents recoil and external protrusions facilitate anchoring. Valve leaflets are constructed of bovine pericardium. The feasibility of catheter implantation, prosthetic valve function, and survival were investigated in an animal model. In vitro and pulse duplicator testing documented valve durability. Endovascular delivery of the prototype stent-valve to the aortic or pulmonary position was feasible. Accurate positioning was required to ensure exclusion of the native valve leaflets and, in the case of the aortic valve, to avoid compromise of the coronary ostia or mitral apparatus. Oversizing of the stent in relation to the valve annulus was desirable to facilitate anchoring and prevent paravalvular insufficiency. Stent-valve implantation proved feasible and compatible with survival in an animal model. Transcatheter implantation of prosthetic valves is possible. Further evolution of this technology will involve lower-profile devices with design features that facilitate vascular delivery, visualization, positioning, deployment, and valvular function.
Webb
John G
JG
Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. webb@providencehealth.bc.ca
Munt
Bradley
B
Makkar
Raj R
RR
Naqvi
Tasneem Z
TZ
Dang
Ninh
N
D000818:Animals; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D002114:Calcinosis / Q000601:surgery; D002404:Catheterization; D002417:Cattle; D020878:Device Removal; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008943:Mitral Valve / Q000601:surgery; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012756:Sheep; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional