Factors Impacting Leaflet Coaptation and Durability in Prosthetic Heart Valves

Abstract

The treatment of Aortic regurgitation using TAVR has not met with excellent outcomes that TAVR did with Aortic stenosis treatment due to differences in patient anatomies, and manifestation of the disease at the native valve annulus. With exception of JenaValve device which relies on proprietary clipping mechanism to anchor the valve, off-label use of TAVR devices that are otherwise indicated for use only to treat AS disease, relied on valve-in-valve for anchoring to prevent paravalvular leakage and valve embolization. The under-expansion of the inside valve due to stiffness and geometry of the outside valve has an impact on leaflet coaptation leading to additional stresses on the leaflets and decreased durability. This article explores the stent frame and leaflet design considerations and their impact on valve durability in AR patient anatomies that rely predominantly on valve-in-valve configuration for anchoring.