Aoun Joe, Zaid Syed, Goel Sachin, Reardon Michael J
Cardiovascular Medicine Department, DeBakey Heart & Vascular Center, Houston Methodist Hospital, TX, USA.
Cardiovascular Medicine Department, VA DeBakey Medical Center, TX, USA.
Heart Int. 2024 Apr 9;18(1):26-29. doi: 10.17925/HI.2024.18.1.4. eCollection 2024.
Transcatheter aortic valve replacement (TAVR) has undergone significant advancements in the last two decades, expanding its indications and refining transcatheter heart valve (THV) and delivery system designs to improve procedural success and patient outcomes. This review focuses on the Navitor™ valve, a third-generation intra-annular Portico™ valve (Abbott Structural Heart, St Paul, MN, USA) designed to address TAVR complications, particularly paravalvular leak (PVL). We present an overview of the Navitor™ system, comparing it to the first-generation Portico™ THV in terms of THV design, key iterations and clinical outcomes. The Navitor™ THV introduces two key refinements-a protective outer sealing skirt and a more flexible delivery system. These enhancements have led to a significant reduction in 30 day PVL rates, from 6.3% with the first-generation Portico™ to 0% with the Navitor™ system. Additionally, the Navitor™ system exhibited lower rates of severe bleeding (27.3% versus 13.1%) and major vascular complications (5.8% versus 0.7%) compared with the first-generation Portico™. The Navitor™ valve represents a promising advancement in TAVR technology, with notable reductions in complications such as PVL, severe bleeding, and major vascular issues, compared with its predecessor. While further research is needed to assess long-term durability, these results underscore its potential benefits in enhancing patient outcomes and reducing complications. This review provides insights into the evolving landscape of TAVR technology and its quantifiable impact on patient care.
在过去二十年中,经导管主动脉瓣置换术(TAVR)取得了重大进展,其适应证不断扩大,经导管心脏瓣膜(THV)和输送系统设计也不断优化,以提高手术成功率和患者预后。本综述聚焦于Navitor™瓣膜,这是一种第三代瓣环内Portico™瓣膜(美国明尼苏达州圣保罗市雅培结构性心脏病公司),旨在解决TAVR并发症,尤其是瓣周漏(PVL)。我们概述了Navitor™系统,并在THV设计、关键迭代和临床结果方面将其与第一代Portico™ THV进行了比较。Navitor™ THV引入了两项关键改进——一个保护性外部密封裙边和一个更灵活的输送系统。这些改进使30天PVL发生率显著降低,从第一代Portico™的6.3%降至Navitor™系统的0%。此外,与第一代Portico™相比,Navitor™系统的严重出血发生率(27.3%对13.1%)和主要血管并发症发生率(5.8%对0.7%)更低。与前代产品相比,Navitor™瓣膜在TAVR技术方面代表了一项有前景的进展,在PVL、严重出血和主要血管问题等并发症方面有显著降低。虽然需要进一步研究来评估长期耐久性,但这些结果强调了其在改善患者预后和减少并发症方面的潜在益处。本综述深入探讨了TAVR技术的不断发展及其对患者护理的可量化影响。