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Houeijeh A, Karsenty C, Combes N, Batteux C, Lecerf F, Remy F, Valdeolmillos E, Petit J, Hascoet S. A Modified Technique for Transcatheter Pulmonary Valve Implantation of SAPIEN 3 Valves in Large Right Ventricular Outflow Tract: A Matched Comparison Study. J Clin Med 2023; 12:7656. [PMID: 38137725 PMCID: PMC10743789 DOI: 10.3390/jcm12247656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/23/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Percutaneous pulmonary valve implantation (PPVI) with a SAPIEN 3 valve is effective for treating treat right ventricle outflow (RVOT) dysfunction. A modified technique was developed without prestenting using a protective valve delivery method. We aimed to compare the procedural results of the modified technique group (MTG) to those of patients in a conventional technique group (CTG). METHODS We designed a matched before-after study. All consecutive PPVI with SAPIEN 3 performed in the MTG over 9 months were matched, based on the RVOT type and size, to consecutive procedures performed previously with SAPIEN 3. RESULTS A total of 54 patients were included, equally distributed in the two groups. The sizes of the SAPIEN 3 valves were 23 mm (n = 9), 26 mm (n = 9), 29 mm (n = 36). The two groups were similar regarding demographic data, RVOT type, and pre-procedure hemodynamics. PPVI was performed in a single procedure in all patients of the MTG, whereas six (22.2%) patients of the CTG group underwent prestenting as a first step and valve implantation later (p = 0.02). The procedures were successful in all cases. Stent embolization was reported in two patients (7.4%) in the CTG, which were impacted in pulmonary arteries. In one case (3.7%), in the MTG, an unstable 29 mm SAPIEN 3 valve was stabilized with two stents and additional valve-in-valve implantation. The hemodynamics results were good in all cases, without significant differences between the two groups. The procedures' durations and fluoroscopy times were significantly reduced in the MTG (48.1 versus 82.6 min, p < 0.0001; 15.2 versus 29.8 min, p = 0.0002). During follow-up, neither stent fracture nor valve dysfunction was noticed in either group. CONCLUSION PPVI without prestenting and with a protective delivery method of the SAPIEN 3 valve significantly reduces the procedure's complexity, the duration, and the irradiation while maintaining excellent hemodynamics results in selected cases.
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Affiliation(s)
- Ali Houeijeh
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Pediatric Cardiology Unit, Lille University Hospital, Laboratoire EA4489, Lille II University, 59000 Lille, France
| | - Clément Karsenty
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Cardiologie Pédiatrique et Congénitale, Université de Toulouse, Hôpital des Enfants, CHU de Toulouse, 31300 Toulouse, France
| | - Nicolas Combes
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Clinique Pasteur, 31300 Toulouse, France
| | - Clément Batteux
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Inserm UMRS999, Université Paris Saclay, 92350 Le Plessis-Robinson, France
| | - Florence Lecerf
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Inserm UMRS999, Université Paris Saclay, 92350 Le Plessis-Robinson, France
| | - Frederic Remy
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
| | - Estibaliz Valdeolmillos
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Inserm UMRS999, Université Paris Saclay, 92350 Le Plessis-Robinson, France
| | - Jérôme Petit
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
| | - Sébastien Hascoet
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Inserm UMRS999, Université Paris Saclay, 92350 Le Plessis-Robinson, France
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Houeijeh A, Sudre A, Juthier F, Godart F. Pulmonary valve replacement in a large and tortuous right ventricle outflow tract with a 32 mm Myval valve under local anaesthesia: challenges and technical considerations: a case report. Eur Heart J Case Rep 2023; 7:ytad322. [PMID: 37547365 PMCID: PMC10404027 DOI: 10.1093/ehjcr/ytad322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/01/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
Background Pulmonary valve replacement in patients with congenital heart diseases and heart failure is challenging. Case summary Here, we describe a case of a patient who had surgical fallot repair with chronic heart failure. Investigations found severe biventricular dysfunction and enlargement due to chronic pulmonary regurgitation. The right ventricle outflow tract was tortuous and large with a diameter of 35 mm. Percutaneous pulmonary valve implantation (PPVI) was done after a challenging pre-stenting. A 32 mm Myval valve over-sized to 35 mm was used for PPVI, which yielded a good result. Discussion A 32 mm Myval valve is effective at extending the possibilities of PPVI in a large and tortuous right ventricle outflow tract not accessible for the other valves.
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Affiliation(s)
| | - Arnaud Sudre
- Cardiac Functional Explorations and Catheterization Unit, ICP, Lille University Hospital, rue Pr. Leclerc, Lille University, UFR3S, 59000 Lille, France
| | - Francis Juthier
- Cardiac Surgery Unit, Lille University Hospital, ICP, rue de Pr.Leclerc Lille University, UFR3S, 59000 Lille, France
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3D-Printing to Plan Complex Transcatheter Paravalvular Leaks Closure. J Clin Med 2022; 11:jcm11164758. [PMID: 36012997 PMCID: PMC9410469 DOI: 10.3390/jcm11164758] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Percutaneous closure of paravalvular leak (PVL) has emerged as an alternative to surgical management in selected cases. Achieving complete PVL occlusion, while respecting prosthesis function remains challenging. A multimodal imaging analysis of PVL morphology before and during the procedure is mandatory to select an appropriate device. We aim to explore the additional value of 3D printing in predicting device related adverse events including mechanical valve leaflet blockade, risk of device embolization and residual shunting. Methods: From the FFPP registries (NCT05089136 and NCT05117359), we included 11 transcatheter PVL closure procedures from three centers for which 3D printed models were produced. Cardiac CT was used for segmentation for 3D printed models (3D-heartmodeling, Caissargues, France). Technology used a laser to fuse very fine powders (TPU Thermoplastic polyurethane) into a final part-laser sintering technology (SLS) with an adapted elasticity. A simulation on 3D printed model was performed using a set of occluders. Results: PVLs were located around aortic prostheses in six cases, mitral prostheses in four cases and tricuspid ring in one case. The device chosen during the simulation on the 3D printed model matched the one implanted in eight cases. In the three other cases, a similar device type was chosen during the procedures but with a different size. A risk of prosthesis leaflet blockade was identified on 3D printed models in four cases. During the procedure, the occluder was removed before release in one case. In another case the device was successfully repositioned and released. In two patients, leaflet impingement was observed post-operatively and surgical device removal had to be performed. Conclusion: In a case-series of complex transcatheter PVL closure procedures, hands-on simulation testing on 3D printed models proved its usefulness to plan and facilitate these challenging procedures.
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