Percutaneous Transcatheter Aortic Valve Implantation: Assessing Results, Judging Outcomes, and Planning TrialsThe Interventionalist Perspective
Paul T.L. Chiam, MBBS, MRCP,
Carlos E. Ruiz, MD, PhD, FACC*
Department of Cardiac and Vascular Interventional Services, Lenox Hill Heart and Vascular Institute, New York, New York.
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Figure 1 Edwards-Sapien PHV
(Top) Bovine pericardium leaflets (blue arrowhead) sutured (expanded polytetrafluoroethylene) (black arrow) onto a stainless steel stent frame (blue arrow). (Bottom) Delivery catheter (Retroflex II, Edwards Lifesciences Inc., Irvine, California) with valve loaded (black arrowhead). PHV = percutaneous heart valve.
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Figure 2 CoreValve PHV
A 12-F delivery catheter shaft (white arrow), 18-F delivery case, which contains valve (black arrow) with a flexible distal nose cone; opened valve consisting of the lower (inlet) portion (small arrowhead), the constrained middle portion to allow coronary perfusion (red arrow), and the upper (outlet) portion (large arrowhead). PHV = percutaneous heart valve.
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Figure 3 Paniagua PHV
(Top) Delivery catheter, which houses the balloon, stent, and valve. (Bottom) Proprietary processing of bovine pericardium with a valve leaflet thickness of 40 µm (arrow). PHV = percutaneous heart valve.
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Figure 4 Enable PHV
Pericardial valve leaflets (black arrow) sutured onto a self-expandable nitinol frame (arrowhead) with pledgets providing support and fixation (red arrow). PHV = percutaneous heart valve.
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Figure 5 AorTx PHV
(Top) Delivery catheter with the valve crimped within. (Bottom) Pericardial leaflets sutured (arrow) onto a self-expandable nitinol stent. PHV = percutaneous heart valve.
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Figure 6 Direct Flow PHV
The valve is constructed of 2 hydrophilic coated inflatable rings (yellow arrows) with bovine pericardial tissue sutured in a noninflatable cylindrical segment that anchors the aortic annulus (green arrow). The valve is controlled with 3 control wires (blue) and is fixed in position by using a permanent polymer to inflate the 2 inflatable rings. PHV = percutaneous heart valve.
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Figure 7 Lotus PHV
(Top) Nitinol valve unsheathed but still attached to delivery catheter. (Middle) Valve after shortening with increase in radial strength; sealing membrane of the valve (white arrow). (Bottom) Valve viewed from the aortic surface with the locks seen (black arrow). PHV = percutaneous heart valve.
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Figure 8 Perceval PHV
(Top) Self-expandable proprietary stent that approximates the shape of the aortic root and sinuses (blue arrows), and the nonexpandable posts (black arrow) that support the pericardial tissue valve. It has a double pericardial sheet that enhances sealing against the native valve (large down-pointing purple/grey arrow) to decrease paravalvular leaks. Note: Large vertical up-pointing arrow signifies direction of blood flow. (Bottom) Valve viewed from the aortic surface with probes through patent coronary ostia (white arrows). cor. = coronaria; dx = dextra (right coronary artery); PHV = percutaneous heart valve; sx = sinestra (left coronary artery).
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Figure 9 JenaValve PHV
A low-profile, repositionable, nitinol, self-expandable stent with pericardial leaflets. The upper portion (arrow) is flared to fixate and orient the valve in the aortic sinus; the eyelets (arrowhead) secure the valve for delivery.
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