Heart valve retrieval in redo transcatheter valve replacement

Degenerative heart valve disease is a growing problem in both the developed world and in the global south. Conventionally, open heart surgery has been used to replace a diseased valve but transcatheter implantation procedures are displacing the surgical approach. Even so, all types of prosthetic tissue valves are likely to degenerate within 7-15 years. The clinically relevant research question thus arises how to optimally treat a failing prosthetic tissue heart valve.

Currently, there are two approaches. One involves open heart surgery to replace the failing valve and the other uses the increasingly popular transcatheter procedure to implant another valve inside the failing valve, so called valve-in-valve. The transcatheter approach inevitably produces a reduction in flow area. Therefore, if both open heart surgery and loss of flow area are to be avoided, particularly in later life, a new technology is needed to address the potential global pandemic looming for heart valve patients over the full life course of their treatment.

With this in mind, the proposed project will design, test and build a prototype valve retrieval system for redo-TVR. An initial concept will be developed using finite element analysis to simulate the valve retrieval process. Once a feasible procedure has been demonstrated in silico, the underlying mechanism will be fabricated and tested in vitro. Scientifically, this project will contribute advances in next generation replacement heart valve technology including the design of the retrieval mechanism and an analysis of its capabilities and reliability in realistic clinical scenarios.