3. Valve and Tissue Optimization to Reduce Stress Leaflet Geometry 17 mm Deep cut to lengthen free margin Extra height increases coaptive surface area Valve designs that reduce leaflet stresses “are likely to have improved performance in long-term applications” 2 Length of commissures reduces stress
16. Advance Procedural Outcomes Improving procedure Skin to Skin Reduce Embolic Events Prepare Landing Zone; Reduce PVL Reduce Vascular Complications Imaging to Aid Valve Positioning and Sizing Reduce Perforations Percutaneous Pacing
17. Pulmonic Valve Expanding possibilities for Congenital Patients Pulmonary Valve for Native Right Ventricular Outflow Tract (RVOT) PA RV
Editor's Notes
The CoreValve PAV was designed specifically for percutaneous implantation. Non-cylindrical frame design incorporates three discrete levels into a single construct and exhibits three separate diameters and three completely different degrees of radial and hoop strength. The inflow portion of the frame exerts higher radial force to ensure secure anchoring in the native aortic annulus. The compliant nature and constant outward force from the self-expanding frame conforms to the patient annulus while maintaining a sealing surface that minimizes paravalvular leak. The center portion of the frame is designed to resist size and shape deformation that is seen. The radial force characteristics of the frame act to decouple the valve from distortion in the annular region The valve leaflets of the bioprosthesis are suprannular. Additionally, the concave design allows for blood flow to the coronary arteries. The outflow portion exerts only low radial force in order to accommodate the ascending aorta. The primary purpose of the outflow portion is to assure optimal flow-orientation.
In addition to porcine pericardium’s inherent durability qualities, CoreValve also incorporates two important design features to reduce bending stresses and ensure long term performance and durability: Optimized leaflet geometry Supra-annular valve location
Maintaining circularity is allows CoreValve to maintain leaflet coaptation despite inflow ellipticity: As ellipticity increases, leaflets typically experience increased prolapsing, buckling, and pinwheeling. This excess bending and buckling can cause increased stresses that may lead to leaflet tearing and potential valve failure. This image shows a CoreValve valve deployed in both a circular and elliptical deployment; in the elliptical deployment, CoreValve maintains complete leaflet coaption with little to no increase in bending or buckling.
Any tool, accessory or technology that can potentially improve the procedure
![CoreValve Design Inflow Portion (with skirt) Constrained Portion (with valve leaflets) Outflow Portion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],High Hoop Strength Low Radial Force High Radial Force ,[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)