Transcatheter valve disease interventional device development

  Transcatheter valve implantation has been studied for more than a decade, and the materials and methods have gradually matured, with transcatheter aortic valve implantation being the most widely used, treating nearly 100,000 patients cumulatively worldwide. It has become an effective treatment method for patients with no hope of previous surgical treatment. Next is the implantation of pulmonary valves, which has been used in more than 5,000 cases worldwide and has proven to be simple, reliable, and safe in clinical applications. Interventional devices for other valve diseases are also being designed and developed, and some of them have already been used in clinical practice, such as mitral valve clamping (more than 7000 cases in total), transcoronary sinus mitral annuloplasty, and valve-in-valve technology for artificial heart valves after biological valve failure. It can be described as a wide variety, comprehensive development and blossoming everywhere. The development of domestic valve disease interventional therapy is slow and lags far behind foreign countries, from material research to application techniques have a huge gap.  1, we have established a whole set of processes for valve material processing, valve suturing, and valve function testing. We firstly analyzed in detail the applied anatomy of the four valve areas in experimental animals, and designed a whole set of equipment for valve material cutting, which provided ideas for the scale production of valves. Secondly, in the processing of valve materials, we have cooperated with biomechanical laboratories of several well-known universities in China, and proposed some new concepts in the issues of biological valve taking, valve material processing, and valve function testing, and basically mastered a whole set of valve processing methods, and focused on the key technologies of how to suture the valve, how to fold the valve for easy delivery, and how to extend the valve life. The valve stents developed in the early stage have obtained ideal data in both in vitro fatigue tests and in vivo experimental studies in animals. The earliest biological valve stent implanted into animals was in October 2007 and has reached 6 years so far, and the recent follow-up visits have confirmed good valve function.  2. We have established new animal models of pulmonary valve insufficiency, tricuspid valve insufficiency arterial model, and acute and chronic aortic valve insufficiency animal models, which provide new experimental methods for the study of interventional devices for valve disease. The animal models established were realized by interventional methods, and the process of establishing the models was simple and the effects were clear. A straight tubular stent was used to implant to the pulmonary valve and squeeze the pulmonary valve to the vessel wall to establish the animal model of pulmonary valve closure insufficiency. A guide wire was used to penetrate the valve leaflet and perform balloon dilation to tear the aortic valve leaflet to establish an animal model of aortic valve insufficiency. In addition, the animal model of tricuspid valve insufficiency was also established by pulling the tricuspid tendon cords using the clamp method.  3, development of a new valve stent system, and related experimental animal studies. At the earliest, we considered that the pressure of the right heart system was relatively low and the feasibility of implanting valve stents was relatively high, and we first studied the implantation of pulmonary valve stents. We developed a “wineglass-like” self-expanding pulmonary artery stent, which could be implanted through the vascular pathway and by puncturing the right ventricular wall, and obtained a relatively satisfactory experimental result. In addition, a balloon-expanded pulmonary valve stent with valve was designed, which also obtained a more satisfactory experimental effect. After the completion of animal experiments on pulmonary valve stent implantation, we carried out experimental studies on tricuspid valve stent implantation with valve, and designed an “hourglass” double-disc tricuspid valve stent with valve, and carried out experimental studies on animals. This novel valve stent device has been recognized by domestic and foreign colleagues, and not only has it received a national invention patent, but the picture of the stent has been cited by foreign renowned experts in many conferences as a relatively novel study on the progress of valve stent research. In the research of aortic valve stent, we have also invested more efforts, early designed a “W” type aorta with valve, and successfully carried out experimental studies on animals. Later, we designed a dumbbell-like self-expanding stent with valve, which is distinguished by the fact that it can be implanted through a relatively small sheath and can be adjusted in position, and the animal experiments were followed up for half a year, and we obtained more satisfactory experimental data. In the last three years, we have developed a self-expanding aortic stent with valve in cooperation with LOPE, which has absorbed some elements of foreign valve stents and made some bold improvements at the same time. In the same period, we have also conducted experimental animal studies on balloon-expandable aortic valve stents, and achieved relatively satisfactory results, and the experimental animals are being followed up. These data will certainly provide the experimental basis for the clinical use of domestic aortic valve stent products.  4.Some new interventional treatment methods for valve disease have been confirmed experimentally. We first proposed the new idea of secondary implantation with valve stent overlay implantation method to solve the prosthetic valve failure and metal fatigue. Experiments have confirmed that transcatheter prosthetic valve secondary implantation is expected to be the preferred method to address biological valve failure and metal material fatigue with safe and feasible operation. This method has been widely used in clinical practice by foreign colleagues. In recent years, through extensive experimental animal studies, we have proposed the implantation of a valved stent over the coronary opening in an emergency situation as a new method of salvage treatment for severe acute aortic dissection injuries, as well as for elderly people with very high-risk aortic valve disease.  In the past few years, transcatheter aortic valve implantation has sporadically been clinically applied in several cardiac centers in China, although this initiative has stimulated the participation of domestic cardiovascular professionals and shortened the gap with foreign countries. However, the author believes that it is almost impossible to carry out this technology on a large scale in the short term because the problem of legalizing the use of imported valve stent systems in China has not been solved yet and the expensive medical costs seriously limit the development of this technology in the country. If the localization of the equipment can be achieved, it may truly solve the difficulties currently faced by this technology. Like many of our domestic counterparts, we are dedicated to research and full of enthusiasm, but we are also soberly aware that it is not easy to realize the localization of equipment. One is that the experimental animal model is completely different from the clinical situation, such as the patient’s aortic valve calcification, stenosis, and aortic dilatation on the valve, and the valve stent is easily positioned and firmly fixed. In contrast, the anatomical structure of the aorta in animal experiments is normal and the anatomical morphology is different, leading to difficulties in positioning and fixing the valve stent in experiments. Even if the experiment is successful, the valve stent applied to the clinic still needs to be redesigned. Second, the approval cycle is long and costly. As a Class III medical device, it takes several years to complete product registration according to the existing approval process. In addition, the number of valve materials sent for testing is large and costly, and businesses are reluctant to get involved. Third, there is a lack of very close cooperation between medical units and companies. A multifaceted, high-level research team needs to be formed to develop a long-term research plan in accordance with international standards. In addition, the relevant national management departments and active participation are needed, such as the organization of experts in materials science and cardiovascular specialties, to develop corresponding technical standards and clinical trial protocols with guidance to ensure that the approval process is standardized and rule-based. Fourth, the technical difficulty. Foreign early 30-day mortality rate of up to 10%, with technical progress and experience accumulation, mortality has been significantly reduced, to reach the current advanced level of foreign countries, it is necessary to form a team in accordance with the high level of requirements standards and strengthen technical training. Through the way of inviting in and going out, we can improve the operational skills of domestic doctors to ensure the healthy development of this technology at a high level.