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SAPIEN valve for percutaneous transcatheter pulmonary valve replacement without "pre-stenting": A multi-institutional experience.
Catheter Cardiovasc Interv. 2019 02 01; 93(2):324-329.CC

Abstract

OBJECTIVES

To describe a multicenter experience of percutaneous transcatheter pulmonary valve replacement (TPVR) using the Edwards SAPIEN S3 valve without the use of a prior stent ("pre-stenting").

BACKGROUND

The SAPIEN S3 and XT valves have durable cobalt-chromium stent frames which may allow for TPVR in large diameter dysfunctional right ventricular outflow tracts (RVOTs) without pre-stenting the landing zone.

METHODS

A retrospective review was performed of all patients with Congenital Heart Disease and dysfunctional RVOT who underwent TPVR using the SAPIEN valve without the use of a pre-stent. Imaging data, procedural elements, and clinical follow-up data were collected to evaluate short and intermediate-term results.

RESULTS

Fifty-seven patients underwent percutaneous placement of the SAPIEN valve in the pulmonary position without the use of pre-stenting. The anatomical substrate varied: native RVOTs (n = 41), conduits (n = 10), and bioprosthetic valves (n = 6). There were no cases in which the valve could not be implanted and no cases of valve embolization or misplacement. On follow-up (range 1 month to 2.2 years, median 5.3 months), no patients had significant obstruction or regurgitation around the valve. There were no frame fractures. There were no procedural deaths. Major complications included severe aortic compression (n = 1) requiring surgical explantation and tricuspid valve injury requiring surgical intervention (n = 2).

CONCLUSIONS

This limited multi-institutional experience demonstrates that the SAPIEN valve can be used for TPVR without the use of a pre-stent without medium-term risk of frame fracture, paravalvar leak, or embolization. Longer term follow-up is required to fully assess this method.

Authors+Show Affiliations

Division of Pediatric Cardiology, Children's Hospital of Colorado, Aurora, Colorado. Division of Cardiology, University of Colorado, Aurora, Colorado.Department of Pediatrics, Division of Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California.Department of Pediatrics, Division of Cardiology, Kaiser Permanente, Los Angeles, California.Division of Pediatric Cardiology, Children's Hospital of Colorado, Aurora, Colorado.Division of Cardiology, University of Colorado, Aurora, Colorado.Division of Pediatric Cardiology, Children's Heart Center of Nevada, Las Vegas, Nevada.Division of Pediatric Cardiology, Children's Heart Center of Nevada, Las Vegas, Nevada.Division of Pediatric Cardiology, Primary Children's Hospital, Salt Lake City, Utah.Division of Pediatric Cardiology, Primary Children's Hospital, Salt Lake City, Utah.Division of Pediatric Cardiology, Children's Hospital of Colorado, Aurora, Colorado.Department of Medicine, Ahmanson Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, Los Angeles, California.Department of Pediatrics, Division of Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California. Department of Medicine, Ahmanson Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, Los Angeles, California.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

30351525

Citation

Morgan, Gareth J., et al. "SAPIEN Valve for Percutaneous Transcatheter Pulmonary Valve Replacement Without "pre-stenting": a Multi-institutional Experience." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 93, no. 2, 2019, pp. 324-329.
Morgan GJ, Sadeghi S, Salem MM, et al. SAPIEN valve for percutaneous transcatheter pulmonary valve replacement without "pre-stenting": A multi-institutional experience. Catheter Cardiovasc Interv. 2019;93(2):324-329.
Morgan, G. J., Sadeghi, S., Salem, M. M., Wilson, N., Kay, J., Rothman, A., Galindo, A., Martin, M. H., Gray, R., Ross, M., Aboulhosn, J. A., & Levi, D. S. (2019). SAPIEN valve for percutaneous transcatheter pulmonary valve replacement without "pre-stenting": A multi-institutional experience. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 93(2), 324-329. https://doi.org/10.1002/ccd.27932
Morgan GJ, et al. SAPIEN Valve for Percutaneous Transcatheter Pulmonary Valve Replacement Without "pre-stenting": a Multi-institutional Experience. Catheter Cardiovasc Interv. 2019 02 1;93(2):324-329. PubMed PMID: 30351525.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - SAPIEN valve for percutaneous transcatheter pulmonary valve replacement without "pre-stenting": A multi-institutional experience. AU - Morgan,Gareth J, AU - Sadeghi,Soraya, AU - Salem,Moris M, AU - Wilson,Neil, AU - Kay,Joseph, AU - Rothman,Abraham, AU - Galindo,Alvaro, AU - Martin,Mary Hunt, AU - Gray,Robert, AU - Ross,Michael, AU - Aboulhosn,Jamil A, AU - Levi,Daniel Steven, Y1 - 2018/10/23/ PY - 2018/05/11/received PY - 2018/08/30/revised PY - 2018/09/23/accepted PY - 2018/10/24/pubmed PY - 2020/2/11/medline PY - 2018/10/24/entrez KW - percutaneous pulmonary valve replacement KW - right ventricular outflow tract stenting KW - stent fracture SP - 324 EP - 329 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 93 IS - 2 N2 - OBJECTIVES: To describe a multicenter experience of percutaneous transcatheter pulmonary valve replacement (TPVR) using the Edwards SAPIEN S3 valve without the use of a prior stent ("pre-stenting"). BACKGROUND: The SAPIEN S3 and XT valves have durable cobalt-chromium stent frames which may allow for TPVR in large diameter dysfunctional right ventricular outflow tracts (RVOTs) without pre-stenting the landing zone. METHODS: A retrospective review was performed of all patients with Congenital Heart Disease and dysfunctional RVOT who underwent TPVR using the SAPIEN valve without the use of a pre-stent. Imaging data, procedural elements, and clinical follow-up data were collected to evaluate short and intermediate-term results. RESULTS: Fifty-seven patients underwent percutaneous placement of the SAPIEN valve in the pulmonary position without the use of pre-stenting. The anatomical substrate varied: native RVOTs (n = 41), conduits (n = 10), and bioprosthetic valves (n = 6). There were no cases in which the valve could not be implanted and no cases of valve embolization or misplacement. On follow-up (range 1 month to 2.2 years, median 5.3 months), no patients had significant obstruction or regurgitation around the valve. There were no frame fractures. There were no procedural deaths. Major complications included severe aortic compression (n = 1) requiring surgical explantation and tricuspid valve injury requiring surgical intervention (n = 2). CONCLUSIONS: This limited multi-institutional experience demonstrates that the SAPIEN valve can be used for TPVR without the use of a pre-stent without medium-term risk of frame fracture, paravalvar leak, or embolization. Longer term follow-up is required to fully assess this method. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/30351525/SAPIEN_valve_for_percutaneous_transcatheter_pulmonary_valve_replacement_without_"pre_stenting":_A_multi_institutional_experience_ L2 - https://doi.org/10.1002/ccd.27932 DB - PRIME DP - Unbound Medicine ER -