Simultaneous Stenting With Edwards SAPIEN Transcatheter Pulmonary Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Pre-stenting the landing zone for transcatheter pulmonary valve replacement (TPVR) is crucial for dilating the right ventricular outflow tract (RVOT), preventing paravalvar leak (PVL), and avoiding conduit tears.
• While simultaneous stenting (SS) with the Melody valve is documented, SS with a SAPIEN valve has not been previously reported.

Purpose of the Study:

• To report the initial experience with a novel technique of simultaneous stenting (SS) using a SAPIEN valve during transcatheter pulmonary valve replacement (TPVR).
• To evaluate the feasibility, safety, and efficacy of SS with SAPIEN valves in preparing the right ventricular outflow tract (RVOT) for TPVR.

Main Methods:

• A retrospective review of patients undergoing SAPIEN TPVR with SS at Rady Children's hospital and UCSD Medical Center.
• Patients received either bare metal stents for long-segment stenosis or covered stents to prevent PVL or conduit tears.

Main Results:

• Seventeen cases of SAPIEN TPVR with SS were identified.
• The majority of RVOTs involved transannular patches (56%), with a mean diameter of 19.6 ± 5.2 mm. Edwards SAPIEN 3 (26.0 mm) valves were most common (59%).
• The procedure was successful in all patients with no conduit tears; minor complications occurred in 17.6%.

Conclusions:

• Simultaneous stenting with SAPIEN TPVR is a viable one-step alternative for patients requiring pre-stenting.
• This technique simplifies the procedure, demonstrates low complication rates, and enhances the landing zone for reduced PVL.