A Hybrid Strategy for Geometrical Reshaping of the Main Pulmonary Artery and Transcatheter Pulmonary Valve Replacement

2021 ◽  
Vol 12 (5) ◽  
pp. 643-648
Author(s):  
Ignacio Lugones ◽  
Jesús Damsky Barbosa ◽  
Guillermo Schvartz ◽  
Judith Ackerman ◽  
Verónica Laudani ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Main Pulmonary Artery ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Landing Zone ◽  
Transcatheter Pulmonary Valve Replacement

Transcatheter pulmonary valve replacement has become an attractive alternative to surgical approach in patients with dysfunctional right ventricular outflow tract. However, in certain cases, an unfavorable anatomy might complicate optimal valve deployment and stability. Several techniques have been described to reshape the landing zone and allow proper implantation of the transcatheter valve. Among them, the hybrid approach has gained attention as an interesting method for off-pump pulmonary valve replacement in patients with dilated right ventricular outflow tract. But to date, there is no standardized method to resize and reshape the landing zone for the stented valve. Here, we describe a reproducible method based on simple geometric rules to allow adequate remodeling of the main pulmonary artery to the desired dimensions in a single attempt, followed by perventricular implantation of a Venus P-valve.

Interposition Technique for Pulmonary Valve Replacement

2021 ◽  
Vol 12 (3) ◽  
pp. 411-413
Author(s):  
Lok Sinha ◽  
Josue Chery ◽  
Richard A. Jonas ◽  
Pranava Sinha
Keyword(s):  
Pulmonary Artery ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Main Pulmonary Artery ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Coronary Compression

Background: Stented bioprosthesis implant at surgical pulmonary valve replacement (PVR) ideally should be 25 to 27 mm to facilitate future percutaneous PVR. This often requires accommodating 35 to 37 mm diameter sewing ring in the pulmonary position and requires anterior patch augmentation of the right ventricular outflow tract (RVOT). We present a novel “interposition” technique of PVR that allows upsizing the valve without RVOT patch augmentation. Methods: Using standard cardiopulmonary bypass, the main pulmonary artery (MPA) is dissected and transected at an appropriate level. The remnants of pulmonary valve leaflets are excised. The valve stent posts are telescoped into distal MPA, the MPA continuity is restored by end-to-end anastomosis of the proximal and distal MPA, with the interposed prosthetic valve sewing ring in the suture line between the two edges of the MPA with the bulk of the sewing ring extravascular. Result: A total of seven patients (tetralogy of Fallot, three; congenital pulmonary stenosis, four; age range: 15-33 years) underwent the procedure. No patient required RVOT patch augmentation, all patients were extubated in the operating room and were fast-tracked to recovery. Our proposed technique of PVR has the following advantages: accommodate larger size valve, eliminates risk of a paravalvar leak, coronary compression, and anterior tilting of the prosthesis. Conclusion: The valve interposition technique avoids the need for RVOT patch, allows implantation of an adequate sized prosthetic valve, maintains native geometry of the pulmonary artery without the risk of tilting of the prosthesis, and eliminates the risk of paravalvular regurgitation and left coronary compression.

scholarly journals Tissue Engineered Transcatheter Pulmonary Valved Stent Implantation: Current State and Future Prospect

2022 ◽  
Vol 23 (2) ◽  
pp. 723
Author(s):  
Zhang Xiling ◽  
Thomas Puehler ◽  
Jette Seiler ◽  
Stanislav N. Gorb ◽  
Janarthanan Sathananthan ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Outflow Tract ◽  
Complex Congenital Heart Disease ◽  
Surgical Interventions ◽  
Transcatheter Pulmonary Valve Replacement

Patients with the complex congenital heart disease (CHD) are usually associated with right ventricular outflow tract dysfunction and typically require multiple surgical interventions during their lives to relieve the right ventricular outflow tract abnormality. Transcatheter pulmonary valve replacement was used as a non-surgical, less invasive alternative treatment for right ventricular outflow tract dysfunction and has been rapidly developing over the past years. Despite the current favorable results of transcatheter pulmonary valve replacement, many patients eligible for pulmonary valve replacement are still not candidates for transcatheter pulmonary valve replacement. Therefore, one of the significant future challenges is to expand transcatheter pulmonary valve replacement to a broader patient population. This review describes the limitations and problems of existing techniques and focuses on decellularized tissue engineering for pulmonary valve stenting.

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