A Modified Technique for Transcatheter Pulmonary Valve Implantation of SAPIEN 3 Valves in Large Right Ventricular Outflow Tract: A Matched Comparison Study

Ali Houeijeh; Clément Karsenty; Nicolas Combes; Clément Batteux; Florence Lecerf; Frederic Remy; Estibaliz Valdeolmillos; Jérôme Petit; Sébastien Hascoet

doi:10.3390/jcm12247656

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 Dec 13;12(24):7656. doi: 10.3390/jcm12247656.

Authors

Ali Houeijeh^{1

2}, Clément Karsenty^{1

3}, Nicolas Combes^{1

4}, Clément Batteux^{1

5}, Florence Lecerf^{1

5}, Frederic Remy¹, Estibaliz Valdeolmillos^{1

5}, Jérôme Petit¹, Sébastien Hascoet^{1

5}

Affiliations

¹ 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.
² Pediatric Cardiology Unit, Lille University Hospital, Laboratoire EA4489, Lille II University, 59000 Lille, France.
³ Cardiologie Pédiatrique et Congénitale, Université de Toulouse, Hôpital des Enfants, CHU de Toulouse, 31300 Toulouse, France.
⁴ Clinique Pasteur, 31300 Toulouse, France.
⁵ Inserm UMRS999, Université Paris Saclay, 92350 Le Plessis-Robinson, France.

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.

Keywords: SAPIEN; congenital heart disease; infective endocarditis; melody; pulmonary valve.

Grants and funding

This research received no external funding.