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Needs Presentation

This presentation by Joe Tartakoff at RIT focuses on critical challenges in mechanical engineering related to transcatheter aortic valve implantation (TAVI), TEVAR procedures, IVC filter removal, the MAZE procedure, and VAD power lines. It highlights the severity of problems like paravalvular leakage and endoleaks, emphasizing the need for improved devices and techniques to enhance surgical outcomes. With a growing number of procedures performed annually, innovation in adhesion, fixation, and ablation methods is essential for patient safety and effectiveness in cardiovascular care.

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Needs Presentation

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  1. Needs Presentation Joe Tartakoff RIT Mechanical Engineering

  2. Paravalvular Leakage in TAVI • Problem: Severity of valve calcification linked to degree of paravalvular aortic regurgitation • Needs: • Better adhesion for valve stenting tocalcified leaflets • Better devices/techniques to reduce the need for balloon redilation or second valve implantation • 45,000 TAVI procedures done worldwide since start, of which 12-20% develop postprocedural PVL (severe aortic regurgitation is rare)

  3. Endoleaks after TEVAR Procedure • Problem: Endoleaks develop in 29% of all TEVAR procedures, leading to increased risk of postprocedural aneurysm rupture • Needs: • Develop better aortic fixation (Type I endoleaks – 40%) • Develop better monitoring of aneurysm sac (Type II endoleaks – 35%) • Develop better connections between graft components (Type III endoleaks – 20%) • 200,000 AAA per year • 30,000 TAA per year

  4. IVC Filter Removal • Problem: Successful removal of IVC filters are rare (3.7% of retrievable IVC filters are actually removed) • Needs: • Develop technique/device to make removal of IVC filters easier for the surgeon (better proximal-distal control) • Develop a new IVC filter that can be removed easily • About 200,000 IVC filters implanted per year in US (use of IVC filters has increased over the last 3 years)

  5. Ablation in Maze Procedure • Problem: MAZE procedures can be time consuming due to non-transmural ablation and variations in the heart’s nervous structure • Needs: • Improve the delivery and outcome of ablations • Develop techniques to design individualized maze pathways • Atrial fibrillation affects roughly 2.5 million people in US

  6. VAD Power Line • Problem: Transcutaneous power cable responsible for most problems with VADs (infection, cable fraying, limiting device lifetime) • Needs: • Stronger and more flexible cable (higher fatigue life) • Reduce infection at the transcutaneous interface (tissue integration) • Roughly 250,000 implanted each year (only 2,000 transplants) • Existing Technology: • Wireless electromagnetic induction (slow recharge time) • Spiral power cable (Jarvic 2000 – still have infection)

  7. Questions/Comments • Association of aortic valve calcification severity with the degree of aortic regurgitation after transcatheter aortic valve implantation. International Journal of Cardiology. 150 (2011) pg. 142-145. • Endoleaks after endovascular repair of thoracic aneurysms. Journal of Vascular Surgery. September 2006 pg. 447- 452. • Retrievable Inferior Vena Cava Filters are Rarely Removed. The American Surgeon. May 2009. Volume 75, Issue 5 pg. 426. • The Maze Porcedure: A surgical intervention for ablation of atrial fibrillation. Heart & Lung: The Journal of Acute and Critical Care. Volume 37, Issue 6 pg. 432-439.

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