The Catharina Hospital says it is the first time in the Netherlands that a smart wire is being used to improve patient outcomes during aortic valve replacement. That smart wire will replace the standard steel wire used in the TAVR procedure.
In the Transcatheter Aortic Valve Replacement (TAVR) treatment technique, the aortic valve is replaced through the femoral artery (perutaneous). The artificial valve is then guided through the inguinal artery using a catheter and placed in its proper location. That procedure uses a long steel wire over which the artificial valve is slid. That wire is also used to get the heart back into the correct rhythm (pacing).
Smart wire
So that steel wire is now being replaced by a smart wire, called the SAVVY wire with built-in technology. “That smart wire has two aspects: the SAVVY wire is completely insulated, so the current through the wire is conducted better and you can be sure of pacing at all times, which is very important for this procedure,” says interventional cardiologist and professor Pim Tonino.
In addition to insulation, the smart wire is also equipped with a pressure sensor that continuously measures the pressure in the left ventricle. “That's virgin territory, we don't know that at all. First you could only measure the pressure at the beginning and at the end of the operation, but not all the steps in between. Until now then. Now we have a continuous view of it from now on. And with that we can further optimize the TAVR,” Tonino said.
Shorter procedure and less complications
The new procedure with the smart wire also has several important advantages for the patient. First, thanks to this technology, the duration of the surgery can be shortened. Pleasant for the patient, but also for the cardiologist and his team, who may therefore be able to help more patients in the same amount of time.
In addition, the addition of the pressure sensor is also expected to result in fewer complications. Because the cardiologist is constantly aware of the pressure in the left ventricle, better decisions can be made. Finally, the cost aspect is also important. “This wire can ensure that we need less material to place the valve. For example, it can save a few hundred euros per procedure,” Tonino said.
Better decision-making
The professor also believes that, more than just by improving TAVR treatment, the smart wire could have a substantial impact on the medical community. Namely, it could lead to better decision-making when deciding whether to place a new aortic valve. “Because it coincides with ongoing research in collaboration with the University of Texas at Houston. We changed the world a good 10 years ago as Catharina Hospital with a new angioplasty method (FFR). This was based on pressure measurements in the coronary artery. This new smart wire and the related research create the possibility to do the same at a different place in the heart,” says Tonino.
Measuring the pressure in the ventricle with this new smart wire, before deciding whether to place a new aortic valve, could improve decision-making. Therefore, the professor says, the ongoing research, subsidized by ZonMW, has enormous potential. It may even lead to a global change in guidelines.
In 2019, during the then edition of Heart Week, the Catharina Hospital already allowed interested parties via WhatsApp and Facebook to watch operations in which a heart valve is replaced. During this year's Heart Week, Pim Tonino gave a presentation on the TAVI procedure with a smart wire.
