On September 4, 2023, at 15:00 local time, the VitaFlow Liberty^® Transcatheter Aortic Valve and Retrievable Delivery System ("VitaFlow Liberty^®"), self-developed by MicroPort^® CardioFlow, VitaFlow Liberty^® was presented at the Police General Hospital in Thailand. Under the leadership of Prof. Luo Jianfang from Guangdong Provincial People's Hospital, Prof. Anuruck Jeamanukoolkit, an expert from the hospital, together with his team, successfully performed the first implantation of VitaFlow Liberty^® in Thailand. Postoperative imaging showed that the patient's valve was in good shape and position, with no perivalvular leakage or coronary occlusion, and the surgery was a complete success.

Professor Anuruck Jeamanukoolkit stated

"The equal response during the release of the aortic valve by VitaFlow Liberty^®, the precise release of the electrically retrievable delivery system, and the strong support of the MicroPort^® CardioFlow professional team have led me to make the decision to tackle the challenge of severe aortic valve regurgitation, which has been a 'blind spot' in the Thai valve TAVI field, as the target for this first implantation."

To witness VitaFlow Liberty ^® Thailand's debut, Prof. Luo Jianfang from Guangdong Provincial People's Hospital, Prof. Anuruck Jeamanukoolkit,Prof. Wasant Soonfuang and Prof. Sakolwat Montrivade from Police General Hospital, Prof. Siriporn Athisakul from King Chulalongkorn Memorial Hospital, Prof. Kid Bhumimuang from Thammasat University Hospital and Prof. Juan Pablo De Brahi from Sanatorio de la Trinidad Mitre were specially invited to join in the surgery together.

Patient’s Basic Information:

The patient is a 74-year-old male diagnosed with severe aortic valve regurgitation with moderate stenosis, severe secondary mitral valve regurgitation with mild stenosis, and severe tricuspid valve regurgitation.

Preoperative echocardiography showed thickening and calcification of the aortic valve leaflets, perforation of the right coronary cusp with flail-like motion, aortic valve area of 19 mmHg, peak velocity of 3.1 m/s, LVEF (left ventricular ejection fraction) of 52%, EuroSCORE Ⅱ of 3.75%, recalibrated TAVI in-hospital mortality risk of 4.76%, and a clinical frailty scale score of 4 points.

Preoperative Echocardiography Assessment Results:

Preoperative CT evaluation showed the patient's aortic valve annulus circumference was 81.8 mm with an average diameter of 26.0 mm, left ventricular outflow tract circumference was 82.6 mm with an average diameter of 26.3 mm, sino-tubular junction circumference was 96.4 mm with an average diameter of 30.7 mm. The heights of the left and right coronary artery openings were 12.4 mm and 16.2 mm, respectively, the valve horizontal angle was 54°, and the aortic arch angle was 119°. There were multiple calcifications in both femoral arteries, but the minimum inner diameter was still acceptable. After thorough discussions among the surgical team and several attending experts, it was decided to use the VitaFlow Liberty^® 30 mm valve with an electrically retrievable delivery system for the TAVI procedure.

Surgical Procedure:

The surgery was performed under general anesthesia. After establishing vascular access through the right femoral artery and placing a 14 F sheath, a pre-shaped stiff guidewire was advanced to the bottom of the aortic sinus, and the delivery system was slowly advanced across the aortic arch and valve. Using the "Cusp Overlap technique" to guide valve positioning, the valve was released at 0 degrees. However, initial imaging indicated that the valve was positioned too deeply, so it was retracted for repositioning. After careful adjustment, the valve was successfully positioned and fully released without perivalvular leakage or coronary artery occlusion.

Academic Lectures:

After the surgery, experts from around the world gathered for four thematic lectures to actively discuss the best TAVI strategies, creating a lively atmosphere.

Product Advantages:

In terms of device design, VitaFlow Liberty^® inherits the performance advantages of its predecessor, including anti-calcification treatment of bovine pericardial leaflets, a double-layer PET skirt, and a self-expanding nickel-titanium alloy stent, which provide better durability and safety. Its breakthrough upgraded delivery system, the only electrically retrievable system on the market, features a unique double reinforced spiral structure that enhances surgical stability and precise deployment.

Professors Juan Pablo De Brahi and Wasant Soonfuang emphasized the operational strategies and clinical advantages of VitaFlow Liberty^® based on the above design features. They provided specific explanations using actual cases: the special double layer PET skirt design effectively reduces the occurrence of perivalvular leakage after TAVI; the high radial force ensures more clinical benefits for patients with severely calcified small annuli; in preventing adverse symptoms such as coronary artery occlusion, its advantages lie in the finer waist and lower-density large cell flower design, which reserve sufficient space for subsequent sheath passage. Additionally, the flexibility of the delivery system and the 360-degree range of motion achieve outstanding deliverability, effectively reducing vascular complications and lowering surgical risks.

Practice Experience Sharing:

To deepen understanding of VitaFlow Liberty^® among Thai valve interventionists, Professor Anuruck Jeamanukoolkit conducted a detailed review and analysis of the first implantation in Thailand. This sparked enthusiastic discussions among the attending experts regarding surgical strategies and the excellent performance of the product. Experts noted that its electric delivery system's innovative double reinforced spiral design and reinforced inner and outer tubes allow for a 1:1 response during release, ensuring stable release without microdislogments. Combined with its valve's high radial force it achieves a "0 microdislogments " from the working position to completely release. Additionally, Professor Sakolwat Montrivade further shared valuable practical experience in using VitaFlow Liberty^® for TAVI in patients with pure aortic valve regurgitation, receiving praise from attending experts for the product's performance advantages.

Conclusion:

In the journey of " Intelligent Manufacturing in Chin" towards internationalization, this marks the first implantation of VitaFlow Liberty^® via catheter aortic valve in Thailand and the third country, after Argentina and Colombia, to venture into the global market. It is believed that this successful deployment will gain more recognition from international scholars for Chinese original interventional devices, further promoting VitaFlow Liberty^® towards the international market. In the near future, it will once again join hands with European surgeons to create more life possibilities for global patients with valvular heart disease!