A modified procedure for percutaneous pulmonary valve implantation of the Edwards SAPIEN 3 valve

Hascoët, Sébastien; Karsenty, Clément; Tortigue, Marine; Watkins, A. Claire; Riou, J.Y.; Boët, Angèle; Tahhan, Nabil; Fabre, Dominique; Haulon, Stéphan; Brenot, Philippe; Petit, Jérôme

doi:10.4244/eij-d-18-00530

Cited by 17 publications

(19 citation statements)

References 5 publications

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“…The uncovered valve is introduced into the pulmonary artery in a short sheath or relatively stiff delivery system, which may result in tricuspid valve injury. The use of a long large-bore sheath covering the valve stent may prevent severe complications, including tear of the tricuspid valve [22].…”

Section: Complicationsmentioning

confidence: 99%

Transcatheter pulmonary valve implantation in 100 patients: a 10-year single-center experience

Rużyłło

Biernacka

Woźniak

et al. 2020

pwki

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Introduction: Transcatheter pulmonary valve implantation (TPVI) is a non-surgical method of treatment for patients with right ventricular outflow tract (RVOT) dysfunction after surgical repair of congenital heart defects (CHD). Aim: To evaluate the long-term results of TPVI performed in a single center. Material and methods: Over 10 years, TPVI was performed in 100 patients (mean age: 26.4 ±8.1 years), using Melody Medtronic or Sapien Edwards valves. Results: The initial success rate of TPVI was 93%. In 7 cases (5 urgent), a switch to surgical intervention was necessary due to periprocedural complications (all patients survived). Following TPVI, none of the 93 patients had severe pulmonary regurgitation. The pulmonary gradient decreased from 49.0 ±37.8 before to 27.6 ±14.9 mm Hg directly after TPVI (p < 0.0001). Right ventricular end-diastolic volume decreased, while NYHA class and pVO 2 uptake significantly improved in 1 year after TPVI. Freedom from reintervention was 100% in 1 year. Freedom from serious adverse events was 86% in mean 5.5 years of observation. The main reason for reintervention was infective endocarditis (IE) (1.6% patients/year). Increased risk of IE was associated with severe PS before valve implantation and the suboptimal result of TPVI. The incidence of IE seems to be lower in patients treated permanently with antiplatelet therapy (1.8% vs. 0.9% patients/year, NS). Conclusions: TPVI is a safe and effective method of treatment in patients with RVOT dysfunction after surgical correction of CHD. To achieve a good outcome, precise patient selection and rigorous IE prevention are necessary.

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Section: Complicationsmentioning

confidence: 99%

Transcatheter pulmonary valve implantation in 100 patients: a 10-year single-center experience

Rużyłło

Biernacka

Woźniak

et al. 2020

pwki

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“…Recently, the modified delivery technique using the 65-cm DrySeal sheath instead of the short e-sheath has been reported. 13,14 The tip of the DrySeal sheath can quite easily be advanced into the distal main pulmonary artery and allows for rapid advancement and coverage of the Sapien valve to the pulmonary position. These studies demonstrated that this technique can facilitate valve delivery and potentially prevent tricuspid valve injury.…”

Section: Discussionmentioning

confidence: 99%

“…11 Recently, an off-label procedural modification has been suggested to minimize tricuspid valve damage with Sapien TPVI: the use of the 65-cm-long caliber DrySeal sheath (W.L Gore & Associates, Inc., Flagstaff, AZ) ( Figure 1b), instead of the shorter 36-cm e-sheath for TPVI with the Sapien valve for delivery. 13,14 The length of the Dryseal sheath allows the Sapien valve to remain "covered" while crossing the tricuspid valve and the RVOT, as the sheath can reach the pulmonary artery when inserted from the femoral vein or the jugular vein. We describe an initial single center experience of the 65-cm-long DrySeal sheath in comparison to the e-sheath for TPVI with the thirdgeneration Edwards S3 valve.…”

Section: Introductionmentioning

confidence: 99%

Utility of the long DrySeal sheath in facilitating transcatheter pulmonary valve implantation with the Edwards Sapien 3 valve

Fukuda¹,

Tan²,

Sadeghi³

et al. 2020

Cathet Cardio Intervent

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Objective: To assess the utility of the 65-cm-long Gore DrySeal sheath when compared to the standard 36-cm-long Edwards expandable sheath (e-sheath) for transcatheter pulmonary valve implantation (TPVI) with the Edwards Sapien 3 valve. Methods: All patients who underwent TPVI with the Sapien 3 valve, excluding those performed via hybrid approach, at our center between September 2015 and November 2019 were retrospectively reviewed and compared between two groups. Results: A total of 94 patients were enrolled; 29 patients underwent TPVI with the Sapien valve using the DrySeal sheath and 65 underwent TPVI using the e-sheath. The height and body weight of patients implanted using the DrySeal sheath ranged from 137 to 193 cm and from 33 to 129 kg, respectively. Valve delivery time was significantly shorter in the DrySeal group (median time 4 min 33 s vs. 9 min 6 s, p = .002). There were no complications in the DrySeal group (0/27). Nine procedural complications occurred in the e-sheath group (9/65), five of which were potentially directly related to sheath choice, including tricuspid valve injury in four and embolization of the tip of the e-sheath during retrieval of a ruptured balloon in one patient. Conclusions: TPVI with the Sapien 3 valve using the 65-cm-long DrySeal sheath facilitates faster and safer valve implantation when compared to the e-sheath.

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“…For the first 10 patients in our series, we utilized a long GDS sheath as has been previously described. [6][7][8] We have further refined the technique by performing additional crimping of the valve after the balloon has been withdrawn into the crimped valve prior to advancing it into the GDS sheath which was performed in the subsequent 13 patients. This allowed the S3 valve to advance through a GDS that was 2 Fr sizes smaller than has been previously reported for the 29 and 26 mm S3 valves.…”

Section: Discussionmentioning

confidence: 99%

“…In this adult-sized patient, the 33 cm sheath reached only up to the inferior vena cava, and once beyond the sheath the balloon was partially inflated to expand the distal tip to create a "carrot" (a cone-like dilation of the tip of the balloon to minimize the size mismatch between the balloon tip and the bare valve). Hascoet et al6 described their experience using the 26 Fr 65 cm GDS sheath to keep the S3 valve covered while it is advanced into the RVOT. To our knowledge this was the first reported experience with using a long sheath to avoid crossing the tricuspid valve with the uncovered SAPIEN Valve.…”

mentioning

confidence: 99%

SAPIEN S3 valve deployment in the pulmonary position using the gore DrySeal sheath to protect the tricuspid valve

Stapleton

Gowda

Bansal

et al. 2020

Cathet Cardio Intervent

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Background: Tricuspid valve injury can occur during implantation of a SAPIEN valve in the pulmonary position. We describe our experience using a long Gore DrySeal (GDS) sheath to protect the tricuspid valve during advancement of the Commander delivery system. Methods: Retrospective single center review of all patients who underwent placement of a SAPIEN valve in the right ventricular outflow tract between January 2016 and April 2020. Patients were divided into two groups: delivery of the valve using standard technique (Group I), and with the use of a GDS (Group II), for comparison. Results: There were 48 patients in total: 25 in Group I and 23 in Group II. In Group II, the first 10 patients had a 29 mm S3 placed through a 26 French (Fr), 65 cm GDS. We then performed additional crimping of the S3 onto the balloon after the balloon catheter was withdrawn to position the valve on the balloon outside the body. Subsequently, seven had a 29 mm S3 placed through a 24 Fr GDS, and four had a 26 mm S3 placed through a 22 Fr GDS including one weighing 16 kg. Two had a 23 mm S3 placed through a 22Fr GDS as the 20Fr GDS was not available in our lab. Severe tricuspid valve injury occurred in 2/25 (8%) of Group I patients and 0/23 of Group II patients. Conclusion: Use of a long GDS may protect the tricuspid valve from injury during implantation of the S3 valve in the pulmonary position, and is technically feasible in smaller patients.

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A modified procedure for percutaneous pulmonary valve implantation of the Edwards SAPIEN 3 valve

Cited by 17 publications

References 5 publications

Transcatheter pulmonary valve implantation in 100 patients: a 10-year single-center experience

Transcatheter pulmonary valve implantation in 100 patients: a 10-year single-center experience

Utility of the long DrySeal sheath in facilitating transcatheter pulmonary valve implantation with the Edwards Sapien 3 valve

SAPIEN S3 valve deployment in the pulmonary position using the gore DrySeal sheath to protect the tricuspid valve

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