Notice of Removal: Pulsed cavitational ultrasound softening: A new non-invasive therapeutic approach of calcified valve stenosis

Histotripsy: the first noninvasive, non-ionizing, non-thermal ablation technique based on ultrasound

“…Current treatments are either surgical aortic valve replacement (AVR) or transcatheter aortic valve replacement (TAVR). In vivo porcine experiments showed the safety and feasibility of using transthoracic histotripsy to noninvasively soften the aortic valve as a native valve repair without the need for a replacement valve [56,57]. d. Fetal intervention -Histotripsy has been investigated to perform noninvasive fetal intervention for treatment and prevention of congenital heart diseases and fetal tumors in a pregnant sheep model [142,143].…”

“…In comparison, lithotripsy can fractionate kidney stones but often results in millimeter-sized fragments that can be difficult to spontaneously pass, and may result in urinary obstruction [145]. f. Tendon -Although collagenous tissues have been shown to be more resistant to histotripsy-induced tissue damage, studies have shown that histotripsy can be used for the partial or complete ablation of tendons for the treatment of musculoskeletal conditions [56] and the noninvasive resection of the basal chordae in the treatment of ischemic mitral regurgitation [57]. g. Bacteria and Biofilms -Biofilm formation on percutaneous and implanted biomedical devices is a common and significant clinical problem that leads to infection and other serious complications.…”

“…The non-thermal nature also enables histotripsy to overcome many of the limitations associated with thermal devices (e.g., heat sink effect, lack of precise margins, and predictability). Histotripsy has been investigated for many pre-clinical applications, including treatment for tumors in the liver [37][38][39][40][41], kidney [23,40,42,43], and prostate [44,45], neurological diseases [46,47], thrombosis [48][49][50][51], hematoma [52][53][54], neonatal and fetal congenital heart disease [17,55], valvular diseases [56,57], kidney stones [58], abscesses [59], tendons [60], and biofilms [61][62][63]. Phase I human trials have been undertaken for histotripsy treatment of benign prostatic hyperplasia [64], liver cancer, and calcified valve stenosis [65], with early results suggesting safety and feasibility in humans.…”

Unbreak My Heart (Valve)

“…The major limitation of this report by Villemain et al. (6) , and therefore the whole therapeutic approach, is that the persistence of the tissue-softening effect on degenerated prostheses was not evaluated, because all animals were sacrificed directly after the procedure. Surgical decalcification often leaves a fibrillar structure that tends rapidly to accumulate calcium.…”

“…In this issue of JACC: Basic to Translational Science , Villemain et al. (6) demonstrated the in vitro efficacy of PCU on human explanted calcified bioprosthetic aortic valves mounted on an artificial heart pump, and they quantified the improvement of the valvular function by elastography. With PCU for approximately 1 h, the investigators showed a reduction in both the mean and maximum gradient of more than 50%.…”