FOCUS ISSUE: CARDIAC INTERVENTION: PERCUTANEOUS VALVE PROSTHESIS
A Repositionable Valved Stent for Endovascular Treatment of Deteriorated Bioprostheses
Rachid Zegdi, MD, PhD*, ,*,
Ziad Khabbaz, MD,
Nicolas Borenstein, DVM and
Jean-Noël Fabiani, MD*,
* Université René Descartes, Paris V, France
AP-HP, Service de Chirurgie Cardio-Vasculaire, Hôpital Européen Georges Pompidou, Paris, France
IMM Recherche, Institut Mutualiste Montsouris, Paris, France.
Manuscript received February 27, 2006;
revised manuscript received July 6, 2006,
accepted July 10, 2006.
* Reprint requests and correspondence: Dr. Rachid Zegdi, Hôpital Européen Georges Pompidou–Service de Chirurgie Cardiovasculaire, 20 Rue Leblanc, 75908 Paris, France. (Email: rzegdi{at}hotmail.com).
OBJECTIVES: We report our animal experience of endovascular valve replacement (VR) of failed bioprosthesis (BP) using an original delivery catheter allowing repositioning of the valved stent (VS).
BACKGROUND: Among the different devices designed for percutaneous VR, none has the potential for repositioning of a fully deployed VS.
METHODS: Five sheep underwent, on beating heart, tricuspid VR with a stented BP. Prolapse of 1 leaflet was induced by tearing. For the endovascular tricuspid VR, we used a VS constructed with a nitinol self-expandable stent and a porcine stentless aortic valve. We also used an original delivery catheter, allowing repositioning of the VS through a compression or relaxation mechanism of the stent.
RESULTS: Epicardial echocardiography and right ventriculography showed severe tricuspid regurgitation, with a regurgitant jet extending to the inferior vena cava. After surgical exposure to the infrarenal inferior vena cava, the VS was successfully implanted inside the failed BP in all cases. Repositioning of the fully deployed VS was always possible. Echocardiographic and macroscopic studies revealed adequate VS positioning, excellent leaflet opening, and absence of any intraprosthetic or periprosthetic leak.
CONCLUSIONS: Endovascular VR was easily performed in sheep with failed BP in the tricuspid position. The novel delivery catheter allowed adequate repositioning of our fully deployed VS before its definitive release. One may anticipate that the safety improvement conferred by this new technology will certainly favor the development of percutaneous VR in clinical practice.
|
Abbreviations and Acronyms
| | BP = bioprosthesis | | SVD = structural valve deterioration | | VR = valve replacement | | VS = valved stent |
|
This article has been cited by other articles:
|
|
|
|
 
A. Lauten, H. R. Figulla, C. Willich, A. Laube, W. Rademacher, H. Schubert, S. Bischoff, and M. Ferrari
Percutaneous caval stent valve implantation: investigation of an interventional approach for treatment of tricuspid regurgitation
Eur. Heart J.,
November 18, 2009;
(2009)
ehp474v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Zegdi, P. Achouh, A. Berrebi, J.-N. Fabiani, D. Blanchard, A. Lafont, B. Cholley, R. Zegdi, A. Lafont, and J.-N. Fabiani
Valve-in-a-Valve Implantation: A Word of Caution
Ann. Thorac. Surg.,
January 1, 2009;
87(1):
347 - 347.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Bottio
The present and the future in aortic stenosis management: are there factors that might preclude surgery?
J. Thorac. Cardiovasc. Surg.,
August 1, 2008;
136(2):
538 - 539.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. T.L. Chiam and C. E. Ruiz
Percutaneous Transcatheter Aortic Valve Implantation: Assessing Results, Judging Outcomes, and Planning Trials: The Interventionalist Perspective
J. Am. Coll. Cardiol. Intv.,
August 1, 2008;
1(4):
341 - 350.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. H. Rahimtoola
The Year in Valvular Heart Disease.
J. Am. Coll. Cardiol.,
February 19, 2008;
51(7):
760 - 770.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Zegdi, V. Ciobotaru, M. Noghin, G. Sleilaty, A. Lafont, C. Latremouille, A. Deloche, and J.-N. Fabiani
Is it reasonable to treat all calcified stenotic aortic valves with a valved stent? Results from a human anatomic study in adults.
J. Am. Coll. Cardiol.,
February 5, 2008;
51(5):
579 - 584.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. M. Flecher, J. W. Curry, T. M. Joudinaud, C. L. Kegel, P. A. Weber, and C. M.G. Duran
Coronary flow obstruction in percutaneous aortic valve replacement. An in vitro study
Eur. J. Cardiothorac. Surg.,
August 1, 2007;
32(2):
291 - 294.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. R. Dixon, C. L. Grines, and W. W. O'Neill
The Year in Interventional Cardiology
J. Am. Coll. Cardiol.,
July 17, 2007;
50(3):
270 - 285.
[Full Text]
[PDF]
|
|
|
|
