Almaty, Kazakhstan – June 2025, coinciding with the 10th anniversary of the Belt and Road Initiative, China’s high-end medical devices achieved a significant breakthrough in the Central Asian market. The VitaFlow Liberty^® Transcatheter Aortic Valve and Retrievable Delivery System (VitaFlow Liberty^®), independently developed by MicroPort CardioFlow Medtech Corporation (CardioFlow, 02160.HK), successfully completed the first four commercial implants in Kazakhstan at the JSC "Research Institute of Cardiology and Internal Diseases," a leading cardiovascular center in the country.

As the second-largest heart valve center in Kazakhstan, the institute enjoys high academic prestige and clinical influence across Central Asia. This milestone marks the official entry of VitaFlow Liberty^®—China’s first CE MDR-certified domestic TAVI system—into the Central Asian market.

The procedures were performed collaboratively by a team of Chinese and Kazakh experts. The Chinese team was led by Professor Chen Mao, Vice Dean of West China School of Medicine, Sichuan University, and Professor Feng Yuan from the Department of Cardiology at West China Hospital, while the Kazakh team was headed by Dr. Alexey, a renowned expert from the institute. Postoperative evaluations confirmed no significant paravalvular leaks or complications in any of the four patients, indicating complete procedural success.

Case 1

Preoperative Assessment

The patient was a 63-year-old male with a tricuspid aortic valve presenting moderate stenosis and severe regurgitation. CT measurements revealed an annular perimeter of 84.9 mm (mean diameter: 27.0 mm), LVOT perimeter of 81.9 mm (mean diameter: 26.2 mm), sinus widths of 34.7 mm/33.6 mm/36.2 mm, STJ mean diameter of 30.2 mm, ascending aorta mean diameter of 37.1 mm, and an annular angulation of 50°.

CT Analysis – Access Assessment

The right access route demonstrated adequate effective inner diameter and bifurcation suitability, confirming it as the primary approach.

Summary and Surgical Strategy

This was a typical tricuspid valve case. A VitaFlow Liberty^® TAV 30 valve was selected based on the annular perimeter. Given the patient’s mild calcification (localized to the left and right leaflets) and absence of anchoring resistance due to non-calcified, non-thickened leaflets, the team opted for direct implantation without predilation, utilizing the system’s straight-stent design and motorized deployment for stability. A high implant position was planned.

Case Outcome

The final result showed a 3 mmHg gradient, no paravalvular leak, an implant depth of 0 mm at the non-coronary sinus and 4 mm below the opposite leaflet, and no complications.

Case 2

Preoperative Assessment

The patient was an 81-year-old female with a tricuspid valve exhibiting severe stenosis, moderate leaflet calcification, and mild thickening. CT measurements revealed an annular perimeter of 78.7 mm (mean diameter: 25.0 mm), LVOT perimeter of 70.6 mm (mean diameter: 22.5 mm), sinus widths of 33.4 mm/31.0 mm/31.8 mm, STJ mean diameter of 26.1 mm, ascending aorta mean diameter of 33.5 mm, and an annular angulation of 45°.

CT Analysis – Coronary Risk Assessment

Left coronary occlusion risk could not be ruled out, while right coronary risk was low.

CT Analysis – Access Assessment

The right access route was deemed suitable as the primary approach, with adequate effective diameter and bifurcation.

Summary and Surgical Strategy

For this typical tricuspid valve case, a VitaFlow Liberty^® TAV 27 valve was chosen per annular perimeter. Calcification was predominantly located on the non-coronary leaflet, with minimal calcification on the left/right leaflets, predisposing the stent to shift toward the left sinus post-deployment. Given the proximity of the left leaflet length to the left coronary ostium-to-sinus floor distance, the team recommended intraoperative 23 mm balloon predilation with angiographic assessment and potential coronary protection.

Case Outcome

No gradient or paravalvular leak was observed. The implant depth was 2 mm at the non-coronary sinus and 5 mm below the opposite leaflet. Timely coronary perfusion obviated the need for a chimney stent, and no complications occurred.

Case 3

Preoperative Assessment

The patient was a 73-year-old male with a functionally bicuspid valve, severe calcification, and fused left-right and right-non commissures. CT measurements showed an annular perimeter of 84.6 mm (mean diameter: 26.9 mm), supra-annular (4/6 mm) pushable space diameters of ~34.5 mm/23.1 mm, LVOT perimeter of 82.1 mm (mean diameter: 26.1 mm), STJ mean diameter of 38.6 mm, ascending aorta mean diameter of 47.8 mm, and an annular angulation of 62°.

CT Analysis – Coronary Risk Assessment

Overall low coronary risk.

CT Analysis – Access Assessment

The right access route was selected as the primary approach, with sufficient effective diameter and bifurcation.

Summary and Surgical Strategy

This case presented a functionally bicuspid valve with calcified fusion at both L-N and R-N commissures. Due to severe calcification resulting in a SupraAnnulus (pushable space above the valve) diameter of only 25.9mm, the surgical team determined that the system's straight-stent design would provide greater orifice area, while its dual-skirt configuration could effectively prevent paravalvular leakage. Therefore, they recommended selecting a VitaFlow Liberty^® TAV 27 valve based on the SupraAnnulus measurement, with 23mm balloon predilation advised.

Case Outcome

A 3 mmHg gradient with no paravalvular leak. Implant depth: 5 mm (non-coronary sinus) and 8 mm (opposite leaflet). No complications.

Case 4

Preoperative Assessment

The patient was a 78-year-old male with a functionally bicuspid valve, moderate calcification, and fused right-non commissure. CT measurements revealed an annular perimeter of 70.4 mm (mean diameter: 22.4 mm), supra-annular (4/6 mm) pushable space diameters of ~20.8 mm/20.1 mm, LVOT perimeter of 72.2 mm (mean diameter: 23.0 mm), STJ mean diameter of 29.0 mm, ascending aorta mean diameter of 38.1 mm, and an annular angulation of 51°.

CT Analysis – Coronary Risk Assessment

Low overall coronary risk.

CT Analysis – Access Assessment

The right access route demonstrated adequate effective inner diameter with suitable bifurcation, though calcification was present at the puncture site. The right approach was selected as the primary access while avoiding the calcified area during puncture.

Summary and Surgical Strategy

Despite moderate calcification in this functionally bicuspid valve, the SupraAnnulus (pushable space above the valve) dimensions remained appropriate for the VitaFlow Liberty^® TAV 24 valve. The operator concluded that the valve's hybrid-density stent design would provide sufficient radial force, thus ruling out downsizing, and a 20mm balloon predilation was recommended.

Case Outcome

The final outcome showed no pressure gradient, no paravalvular leakage, an implant depth of 3 mm at the non-coronary sinus and 7 mm below the contralateral leaflet, and no other complications.

Expert Evaluation

The Case Outcomes were highly praised by the Sino-Kazakh team. Experts highlighted that the collaboration not only introduced China’s mature TAVI experience to Kazakhstan but also validated VitaFlow Liberty^®’s superior clinical performance in complex cases.

Dr. Alexey noted: "The innovative motorized retrievable design of VitaFlow Liberty^® offers greater intraoperative adjustability, enhancing safety and control. The system demonstrated exceptional positioning accuracy and deployment stability, exceeding clinical expectations." He expressed hope for long-term collaboration to advance technological innovation.

Conclusion

As Central Asia’s leading economy and medical innovation hub, Kazakhstan has emerged as a regional core market for TAVI adoption. The successful commercialization of VitaFlow Liberty^® marks a milestone in Sino-Kazakh medical cooperation and elevates the global influence of China’s high-end medical devices. Moving forward, the company will leverage Kazakhstan’s regional advantages to deliver innovative solutions, improving global standards in structural heart disease treatment and benefiting more patients through China’s progress in medical technology.