Novel TAVI Procedure Targets Rheumatic Heart Disease Patients

A simplified transcatheter aortic valve implantation (TAVI) device offers new hope for the thousands of patients with rheumatic heart disease (RHD) who need the procedure each year.

Developed by researchers at the University of Cape Town (UCT; South Africa), the non-occlusive, self-locating TAVI delivery system uses tactile feedback so that the surgeon can stabilize it in the correct position within the aortic root during implantation. It also has a temporary backflow valve to prevent blood leaking backwards into the ventricle. The combination of both factors allows for a slow, controlled implantation, when compared to currently available balloon expandable devices.

As the device is non-occlusive, there is no need to stop blood circulating to the body using a temporary pacemaker in order to induce rapid ventricular pacing (so that the heart beats so quickly it stops blood circulating to the rest of the body). And since it is also self-locating, the device does not require the use of sophisticated cardiac imaging for positioning, and could thus be performed at a fraction of the cost of conventional TAVI. A proof of concept study in a sheep model was presented at the South African Heart Congress, held during September 2016 in Cape Town (South Africa).

“TAVI is only indicated in patients with calcific degenerative aortic valve disease, which is the most prevalent aortic valve pathology in developed countries. In developing countries, RHD still accounts for the majority of patients in need of a heart valve intervention,” said lead author cardiac surgeon Jacques Scherman, MD. “Inspired by the success of TAVI for calcific aortic valve disease, we developed a simplified TAVI device for transcatheter aortic valve replacement in patients with rheumatic heart disease.”

“Knowing from my own Pan-African collaborations how inadequate the provision of cardiac surgery is on the African continent, this fascinating solution promises surgical help for all these young patients with rheumatic heart disease on a continent that has a fair density of general hospitals, but hardly offers any open heart surgery,” commented Professor Karen Sliwa, MD, president of the South African Heart Association (Tygerberg, South Africa).

RHD is caused by rheumatic fever, which results from a streptococcal infection. Patients develop fibrosis of the heart valves, leading to valvular heart disease, heart failure, and death. In Africa alone there are around 15 million patients living with RHD, of whom 100,000 annually may need a heart valve replaced at some stage of their life. The vast majority of these patients have no access to cardiac surgery or sophisticated cardiac imaging.

Related Links:
University of Cape Town
South African Heart Association