Textile transcatheter heart valve prosthesis: state of the art

Today, transcatheter aortic valve replacement (TAVR) has become a largely considered alternative technique to surgical valve replacement in patients who are not operable or patients with high risk for open chest surgery. However, the biological valve tissue used in the devices implanted clinically appears to be a fragile material when folded for low-diameter catheter insertion purpose and released in calcified environment with irregular geometry. Textile polyester material is characterised by outstanding folding and strength properties combined with proven biocompatibility. It could therefore be considered to replace biological valve leaflets in the TAVR procedure. Different issues must, however, be addressed concerning the development of the fabric construction in order to make the material compatible with the valve-requested durability. The performances of a textile valve mainly depend on the ability of the fabric to undergo repeated cyclic loading, the ability of the fibrous construction to resist exaggerated tissue ingrowth with leaflet stiffening and the ability to be crimped into the catheter sheet. The purpose of the present work is to present how a polyester fabric material can address these critical issues, and how the material can be tuned in order to optimise the performance of the device.