{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T22:42:23Z","timestamp":1770072143887,"version":"3.49.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006690","name":"Politecnico di Milano","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006690","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Eng Tech"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>Aortic valve stenosis (AVS) is the most common valvular disease in developed countries. Surgical or transcatheter bioprosthetic aortic valve (AV) replacement is the standard treatment for severe AVS. However, bioprostheses are prone to structural degeneration. Hence, in terms of lifetime management, there is a need for therapies that can postpone AV replacement. With the aim of fragmenting calcifications and restoring AV leaflets flexibility, a new transcatheter debridement device (TDD) exploiting ultrasound is under development. We performed an ex-vivo study on human hearts to quantify how TDD treatment affects stenotic AVs hemodynamic. Additionally, a qualitative histological analysis was performed to assess TDD\u2019s impact on AV leaflets.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Three human hearts affected by AVS were characterized pre- and post-treatment in an ex-vivo beating heart simulator. To replicate physiological flowrates, a pulsatile pump was connected to the left ventricle, while a systemic impedance simulator connected to the aortic root and a reservoir connected to the left atrium closed the hydraulic circuit. Transvalvular pressure drop (\u0394Psys), backflow volume, and effective orifice area (EOA) were evaluated. For histological analysis, AV leaflets sections were stained with Haematoxylin\/Eosin and AlizarineRedS to highlight calcifications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The treatment induced a reduction in \u0394Psys in all tested samples, improving EOA, but caused an increase in backflow volume. Moreover, histology suggested AV leaflets integrity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The TDD procedure improved AV fluid-dynamics during systole in all tested samples, without evidence of damage to tissues. This suggests TDD could be a promising option to postpone AV replacement for patients with AVS.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s13239-025-00774-1","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T20:52:12Z","timestamp":1738788732000},"page":"296-306","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Novel Transcatheter Device to Treat Calcific Aortic Valve Stenosis: An Ex Vivo Study"],"prefix":"10.1007","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0704-5108","authenticated-orcid":false,"given":"Francesca","family":"Perico","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleonora","family":"Salurso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Pappalardo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michal","family":"Jaworek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Fermi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Chiara","family":"Palmieri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavius Constantin","family":"Apostu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Vismara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Vola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,2,5]]},"reference":[{"key":"774_CR1","doi-asserted-by":"publisher","unstructured":"G. Santangelo et al., \u201cThe Global Burden of Valvular Heart Disease: From Clinical Epidemiology to Management,\u201d J. Clin. Med., vol. 12, no. 6, 2023, https:\/\/doi.org\/10.3390\/jcm12062178.","DOI":"10.3390\/jcm12062178"},{"key":"774_CR2","doi-asserted-by":"publisher","unstructured":"S. Badiani, S. Bhattacharyya, N. Aziminia, T. A. Treibel, and G. Lloyd, \u201cModerate aortic stenosis: What is it and when should we intervene?,\u201d Interv. Cardiol. Rev. Res. Resour., vol. 16, 2021, https:\/\/doi.org\/10.15420\/ICR.2021.04.","DOI":"10.15420\/ICR.2021.04"},{"key":"774_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fcvm.2023.1103760","volume":"10","author":"EL Norton","year":"2023","unstructured":"E. L. Norton et al., \u201cTrends in surgical aortic valve replacement in pre- and post-transcatheter aortic valve replacement eras at a structural heart center,\u201d Front. Cardiovasc. Med., vol. 10, no. May, pp. 1\u201310, 2023, https:\/\/doi.org\/10.3389\/fcvm.2023.1103760.","journal-title":"Front. Cardiovasc. Med."},{"key":"774_CR4","doi-asserted-by":"publisher","unstructured":"L. Voigtl\u00e4nder and M. Seiffert, \u201cExpanding TAVI to Low and Intermediate Risk Patients,\u201d Front. Cardiovasc. Med., vol. 5, no. July, 2018, https:\/\/doi.org\/10.3389\/fcvm.2018.00092.","DOI":"10.3389\/fcvm.2018.00092"},{"issue":"8","key":"774_CR5","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1016\/j.jacc.2017.07.715","volume":"70","author":"T Rodriguez-Gabella","year":"2017","unstructured":"T. Rodriguez-Gabella, P. Voisine, R. Puri, P. Pibarot, and J. Rod\u00e9s-Cabau, \u201cAortic Bioprosthetic Valve Durability: Incidence, Mechanisms, Predictors, and Management of Surgical and Transcatheter Valve Degeneration,\u201d J. Am. Coll. Cardiol., vol. 70, no. 8, pp. 1013\u20131028, 2017, https:\/\/doi.org\/10.1016\/j.jacc.2017.07.715.","journal-title":"J. Am. Coll. Cardiol."},{"key":"774_CR6","doi-asserted-by":"publisher","unstructured":"T. T. Lerman, A. Levi, T. H. J\u00f8rgensen, L. S\u00f8ndergaard, Y. Talmor-Barkan, and R. Kornowski, \u201cComparison of middle-term valve durability between transcatheter aortic valve implantation and surgical aortic valve replacement: an updated systematic review and meta-analysis of RCTs,\u201d Front. Cardiovasc. Med., vol. 10, no. September, pp. 1\u20139, 2023, https:\/\/doi.org\/10.3389\/fcvm.2023.1242608.","DOI":"10.3389\/fcvm.2023.1242608"},{"key":"774_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1161\/JAHA.120.018506","volume":"9","author":"AE Kostyunin","year":"2020","unstructured":"A. E. Kostyunin, A. E. Yuzhalin, M. A. Rezvova, E. A. Ovcharenko, T. V. Glushkova, and A. G. Kutikhin, \u201cDegeneration of bioprosthetic heart valves: Update 2020,\u201d J. Am. Heart Assoc., vol. 9, no. 19, pp. 1\u201319, 2020, https:\/\/doi.org\/10.1161\/JAHA.120.018506.","journal-title":"J. Am. Heart Assoc."},{"issue":"2","key":"774_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1161\/CIRCOUTCOMES.118.005481","volume":"12","author":"JRG Etnel","year":"2019","unstructured":"J. R. G. Etnel et al., \u201cBioprosthetic aortic valve replacement in nonelderly adults: A systematic review, meta-analysis, and microsimulation,\u201d Circ. Cardiovasc. Qual. Outcomes, vol. 12, no. 2, pp. 1\u201311, 2019, https:\/\/doi.org\/10.1161\/CIRCOUTCOMES.118.005481.","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"774_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fcvm.2022.850393","volume":"9","author":"G Bernava","year":"2022","unstructured":"G. Bernava et al., \u201cLithotripsy of Calcified Aortic Valve Leaflets by a Novel Ultrasound Transcatheter-Based Device,\u201d Front. Cardiovasc. Med., vol. 9, no. March, pp. 1\u20139, 2022, https:\/\/doi.org\/10.3389\/fcvm.2022.850393.","journal-title":"Front. Cardiovasc. 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Cardio-thoracic Surg., vol. 55, no. 6, pp. 1025\u20131036, 2019, https:\/\/doi.org\/10.1093\/ejcts\/ezz034.","journal-title":"Eur. J. Cardio-thoracic Surg."},{"issue":"4","key":"774_CR14","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1161\/CIRCULATIONAHA.117.030729","volume":"137","author":"D Dvir","year":"2018","unstructured":"D. Dvir et al., \u201cStandardized Definition of Structural Valve Degeneration for Surgical and Transcatheter Bioprosthetic Aortic Valves,\u201d Circulation, vol. 137, no. 4, pp. 388\u2013399, 2018, https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.117.030729.","journal-title":"Circulation"},{"issue":"6","key":"774_CR15","doi-asserted-by":"publisher","first-page":"729","DOI":"10.21470\/1678-9741-2018-0374","volume":"34","author":"A Harky","year":"2019","unstructured":"A. Harky, M. M. Y. Suen, C. H. M. Wong, A. R. Maaliki, and M. Bashir, \u201cBioprosthetic aortic valve replacement in <\u200950 years old patients\u2013 Where is the evidence?,\u201d Brazilian J. Cardiovasc. Surg., vol. 34, no. 6, pp. 729\u2013738, 2019, https:\/\/doi.org\/10.21470\/1678-9741-2018-0374.","journal-title":"Brazilian J. Cardiovasc. Surg."},{"issue":"3","key":"774_CR16","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1067\/mtc.2001.112464","volume":"121","author":"E Pettenazzo","year":"2001","unstructured":"E. Pettenazzo et al., \u201cDynamic in vitro calcification of bioprosthetic porcine valves: Evidence of apatite crystallization,\u201d J. Thorac. Cardiovasc. Surg., vol. 121, no. 3, pp. 500\u2013509, 2001, https:\/\/doi.org\/10.1067\/mtc.2001.112464.","journal-title":"J. Thorac. Cardiovasc. Surg."},{"issue":"9","key":"774_CR17","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1016\/S0002-9149(99)00496-8","volume":"84","author":"RC Bahler","year":"1999","unstructured":"R. C. Bahler, D. R. Desser, R. S. Finkelhor, S. J. Brener, and M. Youssefi, \u201cFactors leading to progression of valvular aortic stenosis,\u201d Am. J. Cardiol., vol. 84, no. 9, pp. 1044\u20131048, 1999, https:\/\/doi.org\/10.1016\/S0002-9149(99)00496-8.","journal-title":"Am. J. Cardiol."},{"key":"774_CR18","doi-asserted-by":"publisher","unstructured":"E. 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