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

Abstract

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 We then performed additional crimping of the S3 onto the balloon after the balloon catheter was withdrawn to position the valve on the balloon outside the body.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.

Transcatheter Pulmonary Valve Replacement: A Review of Current Valve Technologies

“…28,29 Initially, the use of the Novaflex and Commander delivery systems required the valve to be advanced through the right heart uncovered, which resulted in tricuspid valve injury with an incidence of 6% to 8%. 28,30 Thus, a Gore Dryseal (Gore and Associates) sheath is typically used to deliver the valve to the RVOT, which has been shown to significantly reduce the risk of tricuspid valve injury. [30][31][32]…”

“…28,30 Thus, a Gore Dryseal (Gore and Associates) sheath is typically used to deliver the valve to the RVOT, which has been shown to significantly reduce the risk of tricuspid valve injury. [30][31][32]…”

Transcatheter Systemic AV Valve-in-Valve Implantation in a Patient With LTGA and Ebstein Anomaly

“…Recently, large-bore Gore Dry-Seal sheathes (65 cm, 26-F) (Gore and Associates) have been used to protect the TV and facilitate delivery of the transcatheter valve to intended implantation sites in patients with dysfunctional right ventricular outflow tracts. 1 , 2 Anchoring the guidewire in the right ventricle presents a challenge in that the morphologic right ventricular trabeculations prevent the coiled wire from reaching the apex, limiting the landing zone for the delivery sheath and nose-cone.…”

Interventions in Congenital Heart Disease:A Review of Recent Developments: Part I

“…This has been shown to reduce procedural time and the incidence of tricuspid valve injury compared to the standard delivery system. 8,9 As experience evolved, Sapien valve delivery without outflow tract prestenting has been reported without medium-term risk of valve embolization, frame fracture, or paravalvular leak. Avoiding prestenting shortens procedure times and avoids potential stent dislodgement during passage of the valve delivery system.…”