Page 420 - fbkCardioDiabetes_2017

396 Cardio Diabetes Medicine 2017

Percutaneous Heart Repair- Can We Replace

Open Heart Surgery

Dr.Puvi Seshiah, MD, FACC, FSCAI, FRCP (G)
Director, structural Heart Program,

TriHealth Heart Institute, Cincinnati

Coronary angioplasty was the first percutaneous
therapy that revolutionized minimally invasive thera-
pies for heart disease. 2017 is the 40 year anniversa-
th
ry of the first PTCA performed in man. In 1984 the first
mitral balloon valvuloplasty was described by Inoue
followed by aortic valvuloplasty by Dr. Alain Cribier.
This soon led to the first aortic valve implant in a pig
by Dr. Hening Andersen in 1989. First human implant
of catheter based valve was done in 2000 – RV to PA
conduit by Dr. Bonhoeffer.Percutaneous valve thera-
pies have evolved since the first transcatheter aortic
valve implant in 2002. The therapy has changed how
we approach and treat valve disease. Advances in
catheter based technology have led to therapies for Figure 1: Andersen Valve
all of the valves.
Several transcatheter valve companies have brought
This chapter will explore the different valve therapies innovations to improve deliverability and safety of the
that can possibly replace open surgical valve repair/ procedure. Design changes to deal with paravalvular
replacement. leak and smaller delivery catheters which have led to
improved outcomes.
History of Transcatheter Valve Therapy
Hening Rud Andersen was training as an interven-
tional cardiologist in 1989 and was inspired by a pre-
sentation of coronary artery stents. He built a valve
himself bending wires to create a stent and buying
pig hearts from the local butcher shop for the aortic
valves. He then built a transcatheter delivery device
inspired by the Cribier-Letac balloon catheter pio-
neered in France during the 1980s for balloon aortic
valvuloplasty (BAV) by Alain Cribier MD. From con-
ception to proof-of-concept took Andersen just 75
days.

On May 1 , 1989, he implanted the valve in a pig and
st
it survived. His patent was sold to a company that led
to the FIM implant in 2002 by Dr. Cribier in France
via a transeptal approach. (1) Figure 2: Several design advancement in TAVR valves.
Corevalve and Sapien.

GCDC 2017