Percutaneous Pulmonary Valve Replacement: 3-Month Evaluation of Self-Expanding Valved Stents

• Published in: The Annals of thoracic surgery Vol. 82; no. 2; pp. 708 - 713
• Main Authors: Attmann, Tim, Quaden, René, Jahnke, Thomas, Muller-Hulsbeck, Stefan, Boening, Andreas, Cremer, Jochen, Lutter, Georg
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2006; Elsevier Science
• Subjects: Animals; Biological and medical sciences; Bioprosthesis; Blood Pressure; Cattle; Echocardiography; Heart Valve Prosthesis Implantation - methods; Medical sciences; Pulmonary Valve - diagnostic imaging; Pulmonary Valve - pathology; Pulmonary Valve - surgery; Radiography; Sheep; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; 35; Endoprosthesis; Expanding; Respiratory disease; Self evaluation; Surgery; Instrumentation therapy; Replacement; Thorax; Heart valve; Stent; Pulmonary valve; Percutaneous route
• ISSN: 0003-4975; 1552-6259; 1552-6259
• DOI: 10.1016/j.athoracsur.2006.01.096

In a recent study our group established an acute animal model of percutaneous pulmonary valve replacement using self-expanding nitinol stents. The present study was performed to evaluate these valved stents over a 3-month period. Bovine jugular xenografts were sutured into nitinol stents. Transfemoral implantation in the pulmonary position using a modified commercially available application device (with a 22-French outer diameter) was evaluated in 9 sheep. Two sheep died shortly after successful valved stent implantation due to internal venous hemorrhage. Another 1 sheep died 2.5 months after the procedure due to vegetations on the neovalve leading to subtotal stenosis. All other animals survived the 3-month study time (n = 6). An orthotopic pulmonary valved stent position was achieved in 4 animals and a supravalvular position in 1. During the deployment procedure, rhythm disturbances occurred in all animals, and mean arterial blood pressure dropped from 83.9 ± 26.0 mm Hg to 68.3 ± 22.3 mm Hg ( p = 0.006) (n = 5). The peak-to-peak transvalvular gradient was 5.1 ± 4.0 mm Hg initially (n = 5), and 3.6 ± 1.6 mm Hg at follow-up (n = 5). Three-month angiographic and echocardiographic follow-up confirmed competent neovalves without paravalvular leakages. After 3 months of implantation, percutaneously implanted memory nitinol valved stents demonstrated good function in the sheep.