Rationale and Feasibility of Transcatheter Pulmonary Valve Implantation in Small Conduits with the Edwards Sapien Valves

Objectives: Some guidelines do not recommend conduit dilatation above 110% and TPVI in conduits < 16 mm. However, if we want to reach normal values for RVOT diameters and diminish reintervention rates, pushing these boundaries is essential.

Methods: Data of all subsequent patients who underwent TPVI with Edwards Sapien valves in conduits ≤ 16 mm between 2010 and 2020 were analyzed.

Result: In 33 cases, median age was 13 years (5–20 years) and median weight was 47 kg (15–91 kg). Preexisting RVOT grafts were 28 Contegra conduits and 5 homografts (12 mm = 15; 14 mm = 11; 16 mm = 7). Implanted were the Sapien (n = 8), Sapien XT (n = 10), and Sapien 3 valve (n = 15) with 20 mm (n = 4), 23 mm (n = 19), 26 mm (n = 9), and 29 mm (n = 1). Mean minimal RVOT diameter after TPVI was 22.7 ± 2.3 mm (18–30 mm) which is 150% of the mean minimal RVOT diameter before TPVI (15.1 ± 4.3 mm). Covered stents were used in n = 10 cases. Contained conduit rupture occurred in 7 cases (21%). Residual RVOT gradients of 5.7 ± 4.9 mm Hg (0–18 mm Hg) showed adequate RV unloading.

Conclusion: TPVI could be performed successfully in all patients. Dilatation of conduits above 150% and a valve/conduit diameter ratio up to 2.4 were feasible and well tolerated. There was a considerable amount of conduit rupture but all were confined and not significant without further need for intervention or surgery.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021