Self-Expanding Aortic Endoprosthesis for Conduit Preparation Prior to Transcatheter Pulmonary Valve Replacement

Preparation of the right ventricular outflow tract (RVOT) using covered stent placement is a common preparatory step for transcatheter pulmonary valve replacement (TPVR) to reduce the risk of disruption associated with dilating calcified RVOT conduits.

We present a novel method employing a self-expanding covered aortic endoprosthesis and discuss its advantages as an alternative strategy.

Patients with congenital heart disease undergoing RVOT conduit preparation with the GORE TAG Thoracic Branch Endoprosthesis Extender (W.L. Gore & Associates, Newark, DE) followed by TPVR, were prospectively enrolled in a dedicated database. To date, 14 patients have been included. Data on demographics, diagnoses, procedural details, hemodynamic parameters, and outcomes were analyzed.

Fourteen patients (median age: 35 years [range: 18-79]; 57% female) successfully underwent endograft placement immediately before TPVR. Treated conduits included pulmonary homografts (n = 8), surgical bioprostheses (n = 2), Hancock conduit (n = 1), Contegra conduit (n = 1), native RVOT (n = 1), and Melody valve within a surgical bioprosthesis (n = 1). Most patients presented with mixed stenosis and regurgitation (n = 9), with the remaining having stenosis (n = 4) or regurgitation (n = 1). Valves implanted post-preparation included the Sapien S3 valve (Edwards Lifesciences, Irvine, CA) (n = 10) and the Melody valve (Medtronic, Minneapolis, MN) (n = 5). Significant reductions in RVOT systolic gradient were observed (median 34 mmHg pre-procedure to 3 mmHg post-procedure), along with marked conduit expansion (median diameter 13 mm pre-procedure to 25.5 mm post-procedure). No complications were reported.

This study highlights the feasibility of a self-expanding aortic endoprosthesis for RVOT preparation before TPVR. Further comparative study is warranted. Procedural success was achieved in all cases.