Rationale and feasibility of transcatheter pulmonary valve implantation in small conduits with the Edwards Sapien valves

• Published in: International journal of cardiology Vol. 325; pp. 45 - 50
• Main Authors: Tengler, Anja, Ulrich, Sarah, Fischer, Marcus, Pastor-Villaescusa, Belén, Kanaan, Majed, Pozza, Robert Dalla, Haas, Nikolaus A., Jakob, André
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15-02-2021
• Subjects: Conduits; Edwards Sapien valves; Homografts; Transpulmonary valve implantation; Edwards Sapien valves; Conduits; Transpulmonary valve implantation; Homografts
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2020.10.017

Conduit dilatation above 110% and TPVI in conduits <16 mm is not recommended. However, if we want to reach normal values for RVOT diameters and diminish reintervention rates, pushing these boundaries is essential.
Analysis of subsequent patients who underwent TPVI with Edwards Sapien valves in conduits ≤16 mm between 2010 and 2020.
In n = 33 cases median age was 13 years (5–20 y) and median weight 47 kg (15–91 kg). Preexisting RVOT grafts were n = 28 Contegra® conduits and n = 5 homografts (12 mm n = 15; 14 mm n = 11; 16 mm n = 7). Implanted were the Sapien (n = 8), Sapien XT (n = 10) and Sapien 3 valve (n = 15) with 20 mm (n = 4), 23 mm (n = 19), 26 mm (n = 9) and 29 mm (n = 1). Mean minimal RVOT diameter after TPVI was 22,7 ± 2,3 mm (18–30 mm) which is 150% of the mean minimal RVOT diameter before TPVI (15,1 ± 4,3 mm). Covered stents were used in n = 10 cases. Contained conduit rupture occurred in n = 7 cases (21%). Residual RVOT gradients of 5,7 ± 4,9 mmHg (0–18 mmHg) showed adequate RV unloading.
TPVI could be performed successfully in all patients. Dilatation above 150% and a valve/conduit diameter ratio up to 2,4 were well tolerated. There was a considerable amount of conduit rupture but all were confined without further need for intervention or surgery.
•TPVI with Edwards Sapien valves in conduits and homografts ≤ 16 mm is feasible and safeDilatation of conduits above 150% and a valve/conduit diameter ratio up to 2,4 were feasible and well tolerated.•There was a considerable amount of conduit rupture but all were confined without further need for intervention or surgery.•With respect to future valve-in-valve procedures we recommend to aim for the largest possible RVOT diameters.