Update on technologies for cardiac valvular replacement, transcatheter innovations, and reconstructive surgery

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Medical Devices

Background:

• Significant advancements in valvular prostheses have occurred since 2006, with a focus on transcatheter implantation techniques.
• Ongoing innovations aim to enhance the hemodynamics and durability of both aortic bioprostheses and mechanical prostheses, addressing prosthesis-patient mismatch and thrombogenicity.

Purpose of the Study:

• To review recent developmental and investigative advances in valvular prostheses, particularly for transcatheter implantation.
• To highlight technological improvements in bioprosthesis durability and mechanical prosthesis thrombogenicity.
• To discuss the current status and limitations of mitral valve reconstruction and interventional annuloplasty.

Main Methods:

• Review of recent literature and technological developments in valvular prostheses.
• Analysis of design changes in aortic bioprostheses and mechanical prostheses.
• Evaluation of advancements in mitral valve reconstruction and transcatheter therapies.

Main Results:

• Transcatheter aortic valve implantation techniques have advanced, with improvements in retrograde and apical transventricular approaches for aortic stenosis.
• Bioprostheses and mechanical prostheses continue to evolve for better hemodynamics and survival.
• Mitral valve reconstruction techniques are established, but interventional annuloplasty and transcatheter mitral regurgitation devices show limited progress.

Conclusions:

• Catheter-based therapies are emerging for aortic stenosis, but significant advancements for mitral regurgitation are still needed.
• Continued research is crucial for improving valvular prosthesis technology, focusing on durability, hemodynamics, and addressing unmet clinical needs.
• This monograph serves as an educational resource on predominant valvular prosthesis technologies.