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Steps Toward the Percutaneous Replacement of Atrioventricular Valves

An Experimental Study

Younes Boudjemline, MD^_*,,_*, Gabriella Agnoletti, MD^_*, Damien Bonnet, MD^_*,, Luc Behr, DVM, Nicolas Borenstein, DVM, Daniel Sidi, MD^_*, and Philipp Bonhoeffer, MD

^_* Service de Cardiologie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France
EMIU 0016, Pr Lafon, Faculte de Necker, Institut Mutualiste Montsouris, Paris, France
IMM Recherche, Institut Mutualiste Montsouris, Paris, France
Cardiothoracic Unit, Great Ormond Street Hospital, London, England

Manuscript received November 6, 2004; revised manuscript received December 21, 2004, accepted January 11, 2005.

^_* Reprint requests and correspondence: Dr. Younes Boudjemline, Service de Cardiologie Pédiatrique, Hôpital Necker Enfants Malades, 149 Rue de Sévres, 75015 Paris Cedex, France (Email: younes.boudjemline{at}nck.ap-hop-paris.fr).

OBJECTIVES: The goal of this study was to develop a device for percutaneous replacement of the tricuspid valve in animals.

BACKGROUND: Percutaneous valve replacement has recently been introduced, and early clinical experience has been reported. To date, this technique is limited to the replacement of pulmonary and aortic valves in selected patients.

METHODS: A newly designed nitinol stent, forming two large disks separated by a cylinder with a diameter of 18 mm, was specially designed for the purpose of this study. An 18-mm bovine valve was mounted in the central part of the stent, and a polytetrafluoroethylene membrane was sutured onto the ventricular disk. Eight ewes were equally divided into two groups (group 1, acute study; group 2, killed at one month).

RESULTS: Seven of eight devices were successfully delivered in the desired position. In one animal, the device was trapped in tricuspid cordae, leading to its incomplete opening. A significant paravalvular leak was noticed in one animal of group 2. Mean right atrial pressure increased from 5 to 7 mm Hg and did not change during the follow-up. At autopsy, examination confirmed the good position of devices in successfully implanted animals.

CONCLUSIONS: Implantation of a semi-lunar valve in the tricuspid position is possible in ewes through a transcatheter approach. A disk-based nitinol stent is needed to allow valve implantation in the atrioventricular position. These studies open new perspectives into tricuspid as well as mitral valve replacement.

Abbreviations and Acronyms   PA = pulmonary artery   PTFE = polytetrafluoroethylene   RA = right atrium/atrial   RV = right ventricle/ventricular

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