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Mise au point de nouvelles méthodes d’analyse du traumatisme valvulaire des bioprothèses percutanées

Abstract : Transcatheter aortic valve replacement (TAVR) is a growing therapy indicated to treat severe aortic valve stenosis. However, an increasing number of studies demonstrated that crimping and deployment of these bioprostheses induce structural alterations of the pericardial leaflets. These observations raise interrogations concerning the long-term durability of these devices.In this thesis works, we developed tools to analyze pericardial leaflets injuries.The first strategy consisted to determine the differences between bovine and porcine pericardium toward the filtration of various solute.It was possible to observe that porcine pericardium hydraulic conductance was higher (5-folds) and more heterogeneous than bovine pericardium.The second strategy consisted to characterize the lesions induced by deployment of self and balloon expandable valved-stents.After deployment, both types of valved-stents showed an alteration of their pericardial hydraulic conductance.The last strategy was to determine if self-expandable valved-stents crimping could increase their pericardial leaflets calcification. The rabbit model was used as an in-vivo evaluation model.This study showed that the calcium concentration and the mineralization of their pericardial leaflets were unaffected by valved-stents crimping.
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Channing Convelbo. Mise au point de nouvelles méthodes d’analyse du traumatisme valvulaire des bioprothèses percutanées. Médecine humaine et pathologie. Université Paris-Est, 2017. Français. ⟨NNT : 2017PESC0010⟩. ⟨tel-01737742⟩

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