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Use of 65 cm large caliber Dryseal sheaths to facilitate delivery of the Edwards SAPIEN valve to dysfunctional right ventricular outflow tracts
Author(s) -
Kenny Damien,
Morgan Gareth J.,
Murphy Matthew,
AlAlwi Khalid,
Giugno Luca,
Zablah Jenny,
Carminati Mario,
Walsh Kevin
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28409
Subject(s) - medicine , ventricular outflow tract , regurgitation (circulation) , cardiology , pulmonary valve , stenosis , tetralogy of fallot , heart valve , pulmonary valve insufficiency , surgery , pulmonary regurgitation , heart disease
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.