Two-in-one aortic valve sizing and valvuloplasty conductance balloon catheter

• Published in: Catheterization and cardiovascular interventions 2015-07, Vol.86 (1), p.136-143
• Main Authors: Svendsen, Mark C., Sinha, Anjan K., Berwick, Zachary C., Combs, William, Teague, Shawn D., Lefevre, Thierry, Babaliaros, Vasilis, Kassab, Ghassan
• Format: Article
• Language: English
• Subjects: Animals; annular dimensions; Aortic Valve - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - surgery; Balloon Valvuloplasty - instrumentation; Disease Models, Animal; Echocardiography, Transesophageal; Equipment Design; Heart Valve Prosthesis; Ohm's law; paravalvular leak; Prosthesis Design; Swine; TAVR; Tomography, X-Ray Computed
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.25774

Background Inaccurate aortic valve sizing and selection is linked to paravalvular leakage in transcatheter aortic valve replacement (TAVR). Here, a novel sizing valvuloplasty conductance balloon (SVCB) catheter is shown to be accurate, reproducible, unbiased, and provides real‐time tool for aortic valve sizing that fits within the standard valvuloplasty procedure. Methods and Results The SVCB catheter is a valvuloplasty device that uses real‐time electrical conductance measurements based on Ohm's Law to size the balloon opposed against the aortic valve at any given inflation pressure. Accuracy and repeatability of the SVCB catheter was performed on the bench in phantoms of known dimension and ex vivo in three domestic swine aortic annuli with comparison to computed tomography (CT) and dilator measurements. Procedural workflow and safety was demonstrated in vivo in three additional domestic swine. SVCB catheter measurements had negligible bias or error for bench accuracy considered as the gold standard (Bias: −0.11 ± 0.26 mm; Error: 1.2%), but greater disagreement in ex vivo versus dilators (Bias: −0.3 ± 1.1 mm; Error: 4.5%), and ex vivo versus CT (Bias: −1.0 ± 1.6 mm; Error: 8.7%). The dilator versus CT accuracy showed similar agreement (Bias: −0.9 ± 1.5 mm; Error: 7.3%). Repeatability was excellent on the bench (Bias: 0.02 ± 0.12 mm; Error: 0.5%) and ex vivo (Bias: −0.4 ± 0.9 mm; Error: 4.6%). In animal studies, the device fit well within the procedural workflow with no adverse events or complications. Conclusions Due to the clinical relevance of this accurate, repeatable, unbiased, and real‐time sizing measurement, the SVCB catheter may provide a useful tool prior to TAVR. These findings merit a future human study. © 2015 Wiley Periodicals, Inc.