Percutaneous aortic valve replacement (part 2): Miniaturization of the delivery system based on the novel temporary valve technology

Abstract

Percutaneous aortic valve replacement remains an investigational procedure challenged by multiple key issues. In part 1 of this 2 part series, the issue of precise placement of the percutaneous aortic valve was addressed by a novel design of a delivery and deployment system. The design and use of a hemodynamics supporting temporary aortic valve was highlighted, which can stabilize the hemodynamic and local flow conditions for a more controlled and precise placement of the percutaneous aortic valve. In this part 2 study, the issue of vascular access complications is addressed. The current large French size catheter systems can cause significant vascular injuries; the catheter diameter must be reduced for this procedure to be safe and routine. The hemodynamic support of the temporary aortic valve system allows for the formulation of a novel approach to reduce the catheter-delivery system. The miniaturization strategies consist of pretreatment of the aortic annulus and assembly of the percutaneous aortic valve apparatus in a piecemeal fashion of smaller components. Each component would, therefore, require a smaller diameter delivery catheter. The combined strategies as described in this 2 part series aim at realizing the percutaneous aortic valve replacement as a routine, fully percutaneous and cath lab-based.