Current Prostheses for Transcatheter Heart Valve Replacement: A Technical and Clinical Review

Figures

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  Fig. 1.. Current clinical considerations and challenges in TAVR affecting patient evaluation, valve implantation and postoperative care.

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  Fig. 2.. Overview of several balloon (BEV)- and self expandable (SEV) TAVR prostheses in current clinical use. (A) Edwards Lifesciences Sapien 3 (BEV). (B) Edwards Lifesciences Sapien 3 Ultra (BEV). (C) Medtronic Evolut Pro (SEV). (D) Medtronic Evlolut R (SEV). (E) NewValveTechnology Allegra (SEV). (F) Boston Scientific Accurate Neo (SEV). (G) Boston Scientific Accurate Neo 2 (SEV). (H) Abbott Portico (SEV). (I) Abbott Navitor (SEV). (J) JenaValve Trilogy (SEV). (Material provided courtesy of Edwards Lifesciences, Medtronic, NewValve Technology, Boston Scientific, Abbott and JenaValve Technology GmbH. All rights are reserved by each company. © 2022 Boston Scientific Corporation or its affiliates. All rights reserved.© February 2022 Medtronic. Portico and Navitor are trademarks of Abbott or its related companies. Reproduced with permission of Abbott, © 2022. All rights reserved. Used with the permission of Medtronic).

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  Fig. 3.. Covered annular rupture with associated aorto-ventricular defect after implantation of a BEV following borderline oversizing. (A) Surgical situs with introduction of a probe (*) in the RVOT from the aorta and corresponding epicardial hematoma (↗). (B) Four-chamber echocardiographic view after TAVR implantation with a high velocity jet (*) during diastole originating from the aorta until the right ventricular apex. (C) Regurgitation jet (*) in three-chamber view.

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  Fig. 4.. Surgically explanted SEV showing structural valve deterioration (SVD) in form of a commissural leaflet tear (*) which led to severe transvalvular regurgitation and beginning non-structural valve dysfunction (NSVD) with pannus ingrowth from the aortic side (↗) 2 approximately 24 months after implantation. This complication should be avoided by assuring the most appropriate prosthesis selection (EXPLANT-TAVR registry showed high median STS mortality rate of 5%).

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  Fig. 5.. Neuroprotection devices in current clinical use. (A) The Sentinel device (Boston Scientific) is a filter device which is placed in the left carotid artery and the anonymate artery. (B) The TriGuard device (KeyStone Heart) is a deflection device which is positioned in the aortic arch.