A modified procedure for percutaneous pulmonary valve implantation of the SAPIEN 3 valve using a delivery sheath - 14/08/18
, Clément Karsenty, MD 3, Marine Tortigue 1, 2, Jean-Yves Riou, MD 2, 4, Angèle Boet, MD 1, 2, Nabil Tahhan, MD 1, 2, Lucile Houyel, MD 1, 2, Philippe Acar, MD, Ph.D. 2, Stephan Haulon, MD, Ph.D. 2, 5, Dominique Fabre, MD, Ph.D. 2, 5, Philippe Brenot, MD 3, Jérôme Petit, MD 1, 2Résumé |
Background |
The SAPIEN 3 valve (S3) is the latest iteration of the SAPIEN valve family. It is deployed using a low profile flexible Commander delivery system. Hemodynamic outcomes and device durability are promising with SAPIEN valves, but percutaneous pulmonary valve implantation (PPVI) remains difficult. Moreover, the lack of valve covering increases the risk of tricuspid valve injury.
Objectives |
To described the early results of a modified procedure for PPVI of the SAPIEN S3 valve using a delivery sheath.
Methods |
We report the first consecutive cases of a modified procedure for PPVI of the SAPIEN S3 valve using a DryGore Seal 26French 65cm delivery sheath. The sheath was used to stent the right ventricular outflow tract and then for the valve implantation.
Results |
PPVI was performed using the modified technique in 15 patients (mean age 31 yo; mean weight 72.5kg). The most common diagnoses were conotruncal defect (53.3%) and congenital aortic valve disease with Ross surgery (13.3%). A right-ventricle-to-pulmonary-artery tube had been inserted in 20.0% and a homograft or bioprosthesis implanted in 13.3% and 17.7% of patients, respectively. PPVI was performed on the native or patched RVOT in 73.3% of patients. Prestenting was performed in 12 cases with Andrastent XXL in 11 cases and eV3 LD max in 1 case. Prestenting was performed during the same procedure in all cases. While advancing the sheath through the stent, stent embolization occurred in one case. The stent was impacted and moved back with post dilatation and implantation of a second stent. SAPIEN 3 No. 23, No. 26 and No. 29 were implanted in 2, 3 and 10 cases. Valves were successfully implanted in all cases using the delivery sheath. Mean post valve gradient was 3mmHg. Minor paravalvular leak was reported in 2 cases. Mean fluoroscopy time was 26.8min. Groin hematoma were reported in 4 cases (26.7%).
Conclusion |
A delivery sheath allows a fast and safe PPVI of SAPIEN S3 valve.
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Vol 10 - N° 3-4
P. 291 - septembre 2018 Retour au numéro
Article précédent
- Ventricular septal defect associated with aortic valve prolapse: An echocardiographic study
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