Use of 65 cm large caliber Dryseal sheaths to facilitate delivery of the Edwards SAPIEN valve to dysfunctional right ventricular outflow tracts. Issue 3 (13th August 2019)

• Record Type: Journal Article
• Authors: Kenny, Damien; Morgan, Gareth J.; Murphy, Matthew; AlAlwi, Khalid; Giugno, Luca; Zablah, Jenny; Carminati, Mario; Walsh, Kevin
• Is Part Of: Catheterization and cardiovascular interventions. Volume 94:Issue 3(2019)
• Page Start: 409
• Page End: 413
• Publication Date: 2019-08-13
• Subjects: COMV, complications -- PEDI, pediatric intervention -- percutaneous intervention -- PVD, pulmonary valve disease -- vascular access; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.28409
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Background: The Edwards SAPIEN valve and its delivery system may complicate transit through the right heart during transcatheter pulmonary valve replacement (tPVR). We report our early experience using a large diameter, 65 cm delivery sheath to facilitate delivery of the SAPIEN valve to the right ventricular outflow tract (RVOT). Methods: Retrospective analysis of all patients from three large congenital heart centers undergoing tPVR with the Edwards SAPIEN valve delivered with the 65 cm Gore Dryseal Sheath. Results: Over a 12 month period, 30 patients (17 female) with median age 17.5 years (range 8–72) underwent attempted tPVR with the SAPIEN valve delivered using the 65 cm Dryseal sheath (20–26Fr). All procedures resulted in successful valve delivery to the target area. Twenty patients had a native RVOT. The most commonly used valve diameter was 29 mm ( n = 15) with the majority of cases requiring a 26Fr Dryseal sheath ( n = 20). One patient with severe RVOT stenosis underwent prestenting. Median procedure time was 100 min (59–225). No patient had increase in tricuspid valve regurgitation as a consequence of valve delivery. One patient required a synchronous cardioversion for intraprocedural VT and another required ECMO postprocedure due to severe pre‐existing left ventricular dysfunction. On median follow‐up of 5 months, all patients had mild or less pulmonary regurgitation. Median peak Doppler velocity across the pulmonary valve was 2.2 m/s (1.7–4). There were no clinically relevant complications relating to vascular access. Conclusions: Using 65 cm Dryseal sheaths facilitates delivery of SAPIEN valves in patients with dysfunctional RVOTs.