REVIEW OF THE EVOLUTION OF TRANSCATHETER AORTIC VALVE DESIGNS

Highlights

• Analysis of balloon-expandable, self-expanding and mechanically expandable transcatheter heart valve prostheses over the past 20 years has revealed evolutionary technological and design changes in devices aimed at improving biocompatibility, reducing calcification, reducing the diameter of the device profile in a compressed form on the delivery system, as well as increasing the reliability and durability of their operation.
• Promising directions for further improvement of transcatheter prosthetic heart valves have been identified.

Abstract

The analysis of literature data over the past 20 years on the designs of transcatheter prosthetic heart valves for the treatment of cardiovascular diseases is based on sources available to the authors – scientific publications included in the list: Scopus, Web of Science, PubMed, RSCI. The study of trends in the design and changes in the designs of transcatheter prosthetic heart valves over the past 20 years has revealed a number of significant improvements. The use of cobalt-chromium and molybdenum-rhenium alloys instead of stainless steel has increased the strength and performance characteristics of the support frames of balloon-expandable prostheses. Self-expanding prostheses adapt better to the patient's anatomy and reduce the risk of paraprosthetic leakage by optimizing radial forces and increasing cell sizes. Despite the fact that mechanically expandable prostheses were withdrawn due to difficulties with the delivery system, initially, the devices had a unique locking mechanism and provided high installation accuracy, as well as repositioning and complete extraction capabilities. Improving biomaterial processing technologies and improving the geometry of valve linings reduce the risk of calcification and paraprosthetic leaks. Collectively, the applied design changes contribute to improved biocompatibility, reduce the risk of calcification, and ultimately increase the reliability and durability of transcatheter prosthetic heart valves.

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