JIM Today 2018 - Saturday - page 11

Issue 3 
Saturday
 24 February 2018 
JIM today
11
TAVI 1 
Foscolo 
Thursday 
12:45
EVOLUTion of a TAVI family
T
hursday’s programme featured
an exploration of an evolving
transcatheter aortic valve fam-
ily, with Anna Sonia Petronio (Univer-
sity Hospital, Pisa, Italy) walking the
audience through the past, present
and future of the technology.
The self-expandable valve family
was first introduced with the Cor-
eValve (Medtronic, USA) – a tri-leaflet
porcine pericardial tissue valve with
a nitinol frame.
1
Early data with the
device was positive, with all-cause
mortality and stroke rate showing
significant reduction when using the
CoreValve versus surgical aortic valve
replacement (SAVR).
1
However, the
valve – as with other first generation
technologies – had several limitations,
including bulkiness and a need for
large diameter catheters (18-24 F),
vascular complications, permanent
pacemaker requirement, and paraval-
vular leak (PVL).
Dr Petronio stressed that PVL was
under-emphasised in the early years
of TAVI, but its impact became more
and more apparent as time went on.
In the next iteration of the self-
expanding CoreValve family, the
EVOLUT R, PVL was tackled head
on, as well as resolution of several
other limitations present in the first-
generation devices. By reducing the
overall height of the prosthesis – all
the while preserving the height of the
pericardial skirt – the device allowed
superior sealing to reduce PVL.
1
In addition, the EVOLUT R can
be captured and repositioned during
deployment, thus hoping to improve
final placement. “When you have
a valve that
is reposition-
able, you have
the chance of
positioning the
valve the best
you can,” said
Dr Petronio.
“If you are not
satisfied you
can just close
it back and
reposition it.”
The system
also benefits
from a smaller, 14 F delivery system,
opening up the possibility to use the
Continued on page 12
“With EVOLUT R
we have already
demonstrated
a step forward
for the
repositionable
valve.”
Anna Sonia Petronio
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