Self-Expanding Stent and Delivery System for Aortic Valve Replacement

摘要

Currently, aortic valve replacement procedures require a sternotomy and use of cardiopulmonary bypass (CPB) to arrest the heart and provide a bloodless field in which to operate. A less invasive alternative to open heart surgery is transapical or transcatheter aortic valve replacement (TAVR), already emerging as a feasible treatment for patients with high surgical risk. The bioprosthetic valves are delivered via catheters using transarterial or transapical approaches and are implanted within diseased aortic valves. This paper reports the development of a new self-expanding stent for minimally invasive aortic valve replacement and its delivery device for the transapical approach under real-time magnetic resonance imaging (MRI) guidance. Made of nitinol, the new stent is designed to implant and embed a commercially available bioprosthetic aortic valve in aortic root. An MRI passive marker was affixed onto the stent and an MRI active marker to the delivery device. These capabilities were tested in ex vivo and in vivo experiments. Radial resistive force, chronic outward force, and the integrity of bioprosthesis on stent were measured through custom design dedicated test equipment. In vivo experimental- evaluation was done using a porcine large animal model. Both ex vivo and in vivo experiment results indicate that the self-expanding stent provides adequate reinforcement of the bioprosthetic aortic valve and it is easier to implant the valve in the correct position. The orientation and positioning of the implanted valve is more precise and predictable with the help of the passive marker on stent and the active marker on delivery device. The new self-expanding nitinol stent was designed to exert a constant radial force and, therefore, a better fixation of the prosthesis in the aorta, which would result in better preservation of long-term heart function. The passive marker affixed on the stent and active marker embedded in the delivery devices helps to achieve precise orientation and positioning of the stent under MRI guidance. The design allows the stent to be retracted in the delivery device with a snaring catheter if necessary. Histopathology reports reveal that the stent is biocompatible and fully functional. All the stented bioprosthesis appeared to be properly seated in the aortic root.