Method for delivery of prosthetic aortic valve
Methods of delivering a prosthetic aortic heart valve are disclosed. The disclosed methods include loading a prosthetic aortic valve in a collapsed configuration into a delivery sheath so that a selected point on the prosthetic valve is rotationally aligned relative to a long axis of the delivery sheath with a selected radiopaque marker on the delivery sheath, while under fluoroscopic imaging, rotating the delivery sheath about its long axis to align a selected radiopaque marker on the delivery sheath with the selected point on the native aortic valve in a fluoroscopic imaging plane, thereby establishing a desired orientation of the prosthetic aortic valve with respect to the native aortic valve in which the prosthetic valve commissures are rotationally aligned with commissures of the native aortic valve, further advancing the delivery sheath along its long axis until the prosthetic aortic valve is disposed inside the native aortic valve, and deploying the prosthetic aortic valve into an implanted state inside the native aortic valve with the prosthetic aortic valve aligned in the desired orientation with respect to the native aortic valve.
1. A method of implanting a prosthetic aortic valve in a native aortic valve of a patient with a delivery sheath, the prosthetic aortic valve including a stent frame having an interior and three prosthetic valve leaflets mounted within the interior and joined at three respective commissures to provide unidirectional flow of blood through the prosthetic aortic valve, the method comprising:
loading the prosthetic aortic valve, in a collapsed condition, into the delivery sheath;
introducing the delivery sheath along the long axis of the delivery sheath into a femoral artery of the patient;
rotating the delivery sheath so that a selected point on the prosthetic aortic valve is rotationally oriented relative to a long axis of the delivery sheath so that the selected point will be at least substantially in a desired orientation with respect to the native aortic valve, in which orientation the prosthetic valve commissures will be rotationally aligned with commissures of the native aortic valve when the prosthetic aortic valve is disposed inside an annulus of the native aortic valve, after the prosthetic aortic valve has been advanced up the aorta and around a substantially U-shaped turn of an aortic arch of the patient,
after the rotating, advancing the delivery sheath so that the prosthetic aortic valve moves through the aorta and around the substantially U-shaped turn of the aortic arch to a position above the native aortic valve in an ascending aorta of the patient;
further advancing the delivery sheath along its long axis until the prosthetic aortic valve is disposed inside the annulus of the native aortic valve, and
deploying the prosthetic aortic valve into an implanted state inside the annulus of native aortic valve with the prosthetic aortic valve aligned in the desired orientation with the native aortic valve.
2. The method of claim 1 , further comprising:
after the rotating the delivery sheath, fluoroscopically imaging a distal portion of the delivery sheath, the prosthetic aortic valve and the native aortic valve with a fluoroscopic camera to determine whether the prosthetic aortic valve is in the desired orientation; and
if the prosthetic aortic valve is not in the desired orientation, further rotating the delivery sheath about its long axis to disposed the prosthetic aortic valve in the desired orientation.
3. The method of claim 2 , wherein the further rotating the delivery sheath is performed before any portion of the prosthetic aortic valve is in the annulus of the native aortic valve, and before the further advancing the delivery sheath.
4. The method of claim 1 , wherein the delivery sheath includes a radiopaque marker, and wherein the rotating the delivery sheath includes rotationally aligning the selected point on the prosthetic valve with the radiopaque marker of the delivery sheath.
5. The method of claim 4 , wherein the prosthetic aortic valve includes a radiopaque marker, and wherein the loading the prosthetic aortic valve includes rotationally aligning the radiopaque marker of the prosthetic valve with the radiopaque marker of the delivery sheath.
6. The method of claim 2 , wherein the prosthetic aortic valve includes a radiopaque marker, and wherein the further rotating the delivery sheath includes aligning the radiopaque marker with the selected point on the native aortic valve.
7. The method of claim 6 , wherein a portion of the stent frame acts as the radiopaque marker of the prosthetic aortic valve.
8. The method of claim 1 , wherein the stent frame includes a portion at a lower edge thereof, and wherein the deploying the prosthetic aortic valve includes disposing the portion of the stent frame adjacent to the location of conduction tissue of the native aortic valve so that the frame does not damage the conduction tissue.
9. The method of claim 8 , wherein the portion includes a cut-out, recess, or opening.
10. The method of claim 1 , wherein the stent frame includes a portion at a lower edge thereof, the portion of the stent frame being configured to avoid damage to the conduction tissue.
11. The method of claim 1 , wherein the stent frame includes a portion at a lower edge thereof, the portion of the stent frame being configured to avoid high pressure contact against the conduction tissue.
12. The method of claim 1 , wherein the further rotating the delivery sheath is performed while the prosthetic aortic valve is disposed in the ascending aorta and entirely above the annulus of the native aortic valve.
13. The method of claim 1 , further comprising, while rotating the delivery sheath, fluoroscopically imaging the native aortic valve and the prosthetic aortic valve with a fluoroscopic camera.
14. The method of claim 1 , wherein the selected point on the native aortic valve is one of a commissure, a cusp, a nadir of a cusp, or a coronary artery.