REVIEWS   

Minerva Cardioangiologica 2013 February;61(1):33-43

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Experience with anatomically orientated devices for transapical aortic valve implantation

Haensig M. ¹, Holzhey D. M. ¹, Lehmkuhl L. ³, Lehmann S. ¹, Linke A. ², Schuler G. ², Girrbach F. ¹, Moscoso-Luduena M. ¹, Borger M. A. ¹, Rastan A. J. ¹, Mohr F. W. ¹ ✉

¹ Department of Cardiac Surgery, Heart Center of the University of Leipzig, Leipzig, Germany; ² Department of Cardiology, Heart Center of the University of Leipzig, Leipzig, Germany; ³ Department of Diagnostic and Interventional Radiology, Heart Center of the University of Leipzig, Leipzig, Germany

Transcatheter aortic valve implantation (TAVI) is a new technology, which is rapidly growing to a routine procedure amenable for patients with symptomatic aortic valve stenosis and higher than average risk for conventional aortic valve surgery. The crucial disadvantage of TAVI remains the not well foreseeable risk of more than trivial degree of paravalvular leakage and a high rate of atrioventricular block and consecutive pacemaker implantation. In addition, current implantation techniques do not allow controlling the rotation of first-generation devices that might be beneficial regarding optimal physiological valve performance, optimal coronary flow and avoidance of placement of covered commissures in front of the coronary ostia. These shortcomings had pushed the development of second-generation self-expandable nitinol-based devices for subcoronary implantation that aim a reduction of paravalvular leak and AV-block by anatomical orientated positioning into the aortic root. This review focuses on the description of three different TAVI concepts, which are presently under early clinical evaluation, or have recently received commercial approval, using the transapical approach.