Cheng Maobo, Xu Yun, Liu Wei, Mu Lanlan, Lian Xiaoqi, Gao Guobiao, Sun Lei
Center for Medical Device Evaluation, National Medical Products Administration, Beijing 100081, China.
Guangdong-Hong Kong-Macao Greater Bay Area, Center for Medical Device Evaluation and Inspection of NMPA, Shenzhen 518045, China.
Regen Biomater. 2024 Jul 18;11:rbae084. doi: 10.1093/rb/rbae084. eCollection 2024.
For patients with symptomatic and severe tricuspid regurgitation but inoperable with open surgery, transcatheter tricuspid valve intervention (TTVI) is a procedure of great clinical value. TTVI products include repair and replacement devices. TTVI products are one of the hotspots of investigation now, with different innovative biomaterials and structural designs in trials to satisfy divergent indications and reduce complications. With the emerging biomaterials, the technical difficulty of structural design will be greatly reduced, spurring further product innovation and development. The innovativeness and complexity of TTVI products have brought challenges to academia, industry, and regulatory agencies. Regulatory science provides a bridge to address these difficulties and challenges. This perspective article introduces the latest development of the TTVI products. With traditional methods, regulatory agencies face challenges in evaluating the safety and efficacy of TTVr/TTVR devices given the uncertainty of clinical use and the diversity of innovative structural design. This perspective article analyzes the regulatory challenges and discusses regulatory science that can be developed to assess the safety, efficacy, quality and performance of such products: including new approaches for innovative devices, pre-review path, computer modeling and simulation, accelerated wear testing methods for transcatheter heart valves and evidence-based research. This article reveals for the first time how to apply regulatory science systematically to TTVI products, which is of great relevance to their development and translation.
对于有症状的重度三尖瓣反流但无法进行开放手术的患者,经导管三尖瓣介入治疗(TTVI)是一项具有重大临床价值的手术。TTVI产品包括修复和置换装置。TTVI产品是目前研究的热点之一,有不同的创新生物材料和结构设计正在进行试验,以满足不同的适应症并减少并发症。随着新型生物材料的出现,结构设计的技术难度将大大降低,从而推动产品的进一步创新和发展。TTVI产品的创新性和复杂性给学术界、产业界和监管机构带来了挑战。监管科学为解决这些困难和挑战提供了一座桥梁。这篇观点文章介绍了TTVI产品的最新进展。采用传统方法时,鉴于临床使用的不确定性和创新结构设计的多样性,监管机构在评估TTVr/TTVR装置的安全性和有效性方面面临挑战。这篇观点文章分析了监管挑战,并讨论了可开发用于评估此类产品的安全性、有效性、质量和性能的监管科学:包括创新装置的新方法、预审查途径、计算机建模与模拟、经导管心脏瓣膜的加速磨损测试方法以及循证研究。本文首次揭示了如何将监管科学系统地应用于TTVI产品,这对其开发和转化具有重要意义。