Transcatheter aortic valve resection: new mechanical devices.

Area of Science:

• Cardiovascular Surgery
• Medical Device Technology
• Interventional Cardiology

Background:

• Transcatheter aortic valve implantation (TAVI) outcomes can be improved by addressing aortic cusp anatomy.
• Mechanical transcatheter resection devices are being explored for pre-ablation of aortic cusps.

Purpose of the Study:

• To evaluate the feasibility and performance of three mechanical transcatheter resection devices.
• To compare device efficacy in terms of resection time, resected area, and tissue damage.

Main Methods:

• Three mechanical transcatheter resection devices were tested in porcine (n=30) and human calcified valves (n=54).
• Key metrics included resection time, resected valve area, cusp release, and surrounding tissue damage.
• Postmortem transapical-transcatheter-resections were performed in two human cadavers.

Main Results:

• Aesculap II showed significantly shorter resection times in porcine models but caused more tissue damage.
• R&R II device resected fewer cusps and a smaller total area, but with larger fragment sizes.
• Human valve resections mirrored porcine findings for time and area, but not fragment size.

Conclusions:

• Transcatheter aortic valve resection is a feasible procedure.
• Device choice influences resection efficiency and potential for collateral tissue injury.
• Further research may optimize devices for TAVI procedures.