Selfexpanding anatomically correct transapical aortic valve implantation Ehud

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Self-expanding, anatomically correct transapical aortic valve implantation Ehud Schwammenthal, MD, Ph. D Associate Professor

Self-expanding, anatomically correct transapical aortic valve implantation Ehud Schwammenthal, MD, Ph. D Associate Professor of Cardiology Sheba Medical Center, Tel Hashomer, Israel

DISCLOSURES Ehud Schwammenthal, MD, Ph. D Consulting Fees – Medtronic Cardio. Vascular, Inc. Honoraria

DISCLOSURES Ehud Schwammenthal, MD, Ph. D Consulting Fees – Medtronic Cardio. Vascular, Inc. Honoraria – Medtronic Cardio. Vascular, Inc. The Engager device is not commercially available in any geography and only available for Clinical Study in the EU

Medtronic Engager Design Concept • • Self-expandable transcatheter valve Minimizes pressure loss at the

Medtronic Engager Design Concept • • Self-expandable transcatheter valve Minimizes pressure loss at the inlet Maximizes pressure recovery at the outlet Optimized fluid dynamic shape (Venturi tube) allows to avoid oversizing of the diameter at annular-leaflet level Resulting shape – inlet, waist, outlet – creates an optimal anatomic fit facilitating intuitive deployment and axial fixation

Valve Hemodynamics EOA: 1. 62 cm 2 (5 L/min) Producing the hemodynamics of a

Valve Hemodynamics EOA: 1. 62 cm 2 (5 L/min) Producing the hemodynamics of a 23 valve without oversizing at the native aortic orifice (CE Magna 21: 1. 48 cm 2 , Mitroflow 23: 1. 57 cm 2)* *Gerosa et al, The Journal of Thoracic and CV Surgery, May 2006

Medtronic Engager Transcatheter Valve Dedicated commissural posts Nitinol main frame Scalloped bovine pericardial leaflets

Medtronic Engager Transcatheter Valve Dedicated commissural posts Nitinol main frame Scalloped bovine pericardial leaflets Nitinol support frame Polyester skirt

O A R Medtronic Engager Rotational Positioning R N L

O A R Medtronic Engager Rotational Positioning R N L

Medtronic Engager Rotational Positioning LA O R N L 7

Medtronic Engager Rotational Positioning LA O R N L 7

1. Establish delivery axis as the commissure between 2 sinuses 2. Align window of

1. Establish delivery axis as the commissure between 2 sinuses 2. Align window of prosthetic commissural post with native one LCS RCS CRL Delivery Axis Commissure is the tip of the intercusp triangle spared by contrast medium

Taped Case (edited to 5: 30 minutes) Details of the FIM will be presented

Taped Case (edited to 5: 30 minutes) Details of the FIM will be presented at 4: 40 p. m.

Post-Implantation rotational angiography (Dyna CT)

Post-Implantation rotational angiography (Dyna CT)

Summary – Medtronic Engager • Self-guided, reproducible and intuitive deployment into an anatomically correct

Summary – Medtronic Engager • Self-guided, reproducible and intuitive deployment into an anatomically correct position • Relies on axial in addition to radial forces for fixation • Leaves the coronary ostia unobstructed and accessible • Reduces the risk of perivalvular regurgitation • Applies proven surgical design standards for longterm durability

Thank You !

Thank You !

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