Percutaneous Pulmonary Valve Implantation

Giugno L, Faccini A, Carminati M.

Korean Circ J. 2020 Apr;50(4):302-316. doi: 10.4070/kcj.2019.0291. Review.

PMID: 32157831 Free PMC Article

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Abstract

Percutaneous pulmonary valve implantation (PPVI) is recognized as a feasible and low risk alternative to surgery to treat dysfunctional right ventricular outflow tract (RVOT) in usually pluri-operated patients. Evolving technology allowed to develop different kind of prosthesis and to go from an initial treatment exclusively of stenotic conduit to an actual approach extended also to wide native RVOT. The Melody transcatheter pulmonary valve (TPV) and the Edwards Sapien valve are nowadays the most commonly implanted prostheses. However, other devices have been developed to treat large RVOT (i.e., the Venus p-valve, the Medtronic Harmony TPV, the Alterra Adaptive Prestent, and the Pulsta valve). Indications for PPVI are the same as for surgical interventions on pulmonary valve, with limits related to the maximum diameter of the available percutaneous prosthesis. Therefore, an accurate preoperative evaluation is of paramount importance to select patients who could benefit from this procedure. The overall periprocedural mortality incidence is around 1.4%, while freedom from RVOT reintervention ranges from 100% at 4 months to 70% at 70 months, according to the different published studies.

 

Figure 1. Melody valve. A modified bovine giugular vein with valve segment sutured on Numed Platinum Iridium stent; the stent can be crimped down to 6 mm, mounted on a BIB balloon and re-expanded up to 18, 20, and 22 mm. The delivery system is shown in the lower part of the figure.

Figure 2. The evolution of Edwards Sapien Valve. (A) Edwards Sapien, (B) Edwards Sapien XT, and (C) Edwards Sapien 3.

Figure 3. 3D rotational angiography and 3D Examples of reconstruction. (A) Ao and PA reconstruction. (B) Relationship between a balloon inflated into the right ventricular outflow tract (ballon) and the left anterior descending artery (left coronary). 3D = three-dimensional; Ao = aortic; PA = pulmonary artery.

Figure 4. Balloon interrogation showing Ao root distorsion (arrow). Ao = aortic.

Figure 5. Balloon interrogation showing compression of the left coronary artery (arrow).

Figure 6. Prestenting + Melody. (A) Right ventricular angiogram in a case of stenotic right ventricular to pulmonary artery conduit (arrow). (B) Angiogram after Melody implantation (black arrow), after prestenting with bare metal stent Andra (white arrow). PA = pulmonary artery; RV = right ventricle.

Figure 7. Melody implantation + prestenting with covered stent in a conduit with extensive calcifications (arrows). (A) Basal angiogram. (B) Angiogram after Melody implantation. PA = pulmonary artery; RV = right ventricle.

Figure 8. Step by step Sapien valve implantation tecnique in native RVOT. (A, B) Basal RVOT angiography. (C, D) Balloon inflation test + simultaneous right ventricular injection, showing no residual dye passage. (E) Dryseal long sheath advanced up to main pulmonary artery. (F) Sapien valve advanced into the sheath (arrow). (G, H) Sapien valve implanted (arrow). PA = pulmonary artery; RV = right ventricle; RVOT = right ventricular outflow tract.

Figure 9. Transesophageal echo pictures of Sapien valve.

 

source:https://pubmed.ncbi.nlm.nih.gov/32157831/

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