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Piriou PG, Plessis J, Manigold T, Letocart V, Le Ruz R, Padovani P, Guérin P. Standardized Bench Test Evaluation of Biomechanical Characteristics of Stents Used in Right Ventricular Outflow Tract Revalvulation. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00726-1. [PMID: 38468115 DOI: 10.1007/s13239-024-00726-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/26/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Pre-stenting of the right ventricular outflow tract (RVOT) is commonly performed before percutaneous pulmonary valve implantation (PPVI), to relieve obstruction, prevent valved stent fractures, and provide a landing zone. This study aimed to evaluate the biomechanical characteristics of the stents currently used to perform pre-stenting of the RVOT. METHODS We assessed five commercially available stents: Cheatham-Platinum Stent ("CP Stent"), AndraStent XL, AndraStent XXL, Optimus XL, and Optimus XXL. Following stent deployment at nominal pressure, radial and longitudinal elastic recoils and radial resistance were measured. The bending stiffness of the stents crimped onto the balloons was also evaluated. RESULTS Three samples were tested for each stent. Our study showed no significant difference between the stent platforms in terms of radial elastic recoil, which was relatively low (< 10%). The longitudinal elastic recoil was also low for all the devices (< 5%). Significant differences were observed in radial resistance (P < 0.001). CP Stent and AndraStent XL exhibited the highest radial resistances. The bending stiffnesses of the stents crimped on their balloons were significantly different (P < 0.00001). Optimus XL and XXL were more flexible than the other stents. CONCLUSION This study highlights the significant differences between the stents currently used in RVOT pre-stenting. Stents with good radial resistance are preferred, especially for calcified vessels, and flexibility is crucial for tortuous vessels. We proposed an algorithm for selecting the most suitable stent according to the need for radial force and flexibility, which will help inform clinicians considering RVOT revalvulation.
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Affiliation(s)
- Pierre-Guillaume Piriou
- Nantes Université, CHU Nantes, Service de Cardiologie, l'institut du Thorax, 44000, Nantes, France.
| | - Julien Plessis
- Nantes Université, CHU Nantes, Service de Cardiologie, l'institut du Thorax, 44000, Nantes, France
| | - Thibaut Manigold
- Nantes Université, CHU Nantes, Service de Cardiologie, l'institut du Thorax, 44000, Nantes, France
| | - Vincent Letocart
- Nantes Université, CHU Nantes, Service de Cardiologie, l'institut du Thorax, 44000, Nantes, France
| | - Robin Le Ruz
- Nantes Université, CHU Nantes, Service de Cardiologie, l'institut du Thorax, 44000, Nantes, France
| | - Paul Padovani
- Nantes Université, CHU Nantes, Service de Cardiologie, l'institut du Thorax, 44000, Nantes, France
| | - Patrice Guérin
- Nantes Université, CHU Nantes, Service de Cardiologie, l'institut du Thorax, 44000, Nantes, France
- INSERM Unit 1229, Regenerative Medicine and Skeleton, Nantes, France
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Ueyama HA, Greenbaum AB, Leshnower BG, Keeling B, Block PC, Byku I, Ligon RA, Grier E, Shekiladze N, Gleason PT, Xie J, Kim DW, Babaliaros VC, Duwayri Y. Physician-Modified Endograft-Facilitated Transcatheter Pulmonary Valve Replacement in Large Right Ventricular Outflow Tract. Circ Cardiovasc Interv 2023; 16:e013123. [PMID: 37577788 DOI: 10.1161/circinterventions.123.013123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Transcatheter pulmonary valve replacement (TPVR) in patients with a congenital or acquired abnormality resulting in enlarged right ventricular outflow tract (RVOT) is challenging and may preclude treatment with dedicated devices. We describe a technique using a physician-modified endograft to facilitate TPVR. METHODS Six patients underwent physician-modified endograft-facilitated TPVR for severe symptomatic pulmonary insufficiency with enlarged RVOT. The fenestration was created in a commercially available endograft before implantation, which was then deployed from the dominant branch pulmonary artery into the RVOT, with the fenestration aligned with the ostium of the nondominant pulmonary artery. A covered stent was placed through the fenestration into the nondominant branch pulmonary artery, and a transcatheter heart valve was deployed within the endograft at the level of the original pulmonary valve. RESULTS Four patients had tetralogy of Fallot, 1 had pulmonary atresia, and 1 had rheumatic valve disease. The RVOT/main pulmonary artery was severely enlarged (diameter, 44.2 [43.5-50.6] mm). All patients had reduced right ventricular (RV) function and dilated RVs (RV end-diastolic volume, 314 [235-316] mL). Successful endograft, covered stent, and transcatheter heart valve deployment were achieved in all cases without stent/valve embolization, vascular complications, or bleeding complications. At 30 days, 1 patient had mild pulmonary insufficiency, while others had none. The RV size measured by echocardiography was significantly reduced after TPVR (RV area, 34.4 [baseline] versus 29.0 [pre-discharge] versus 25.3 [30 days] cm2; P=0.03). During median follow-up of 221.5 (range, 29-652) days, there were no deaths or need for pulmonary valve reintervention. One patient developed severe tricuspid regurgitation due to entrapment of the anterior tricuspid leaflet by the endograft. The patient underwent successful tricuspid replacement and resection of the offending endograft with preservation of the pulmonary valve prosthesis. CONCLUSIONS Simple fenestration of an off-the-shelf endograft and associated covered stent placement through the fenestration allows TPVR for patients with dysfunctional native or patch-repaired pulmonary valves and RVOT enlargement.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery (B.G.L., B.K.), Emory University School of Medicine, Atlanta, GA
| | - Brent Keeling
- Division of Cardiothoracic Surgery (B.G.L., B.K.), Emory University School of Medicine, Atlanta, GA
| | - Peter C Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - R Allen Ligon
- Division of Cardiology, Children's Healthcare of Atlanta (R.A.L., D.W.K.), Emory University School of Medicine, Atlanta, GA
| | - Elizabeth Grier
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Nikoloz Shekiladze
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Patrick T Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Joe Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Dennis W Kim
- Division of Cardiology, Children's Healthcare of Atlanta (R.A.L., D.W.K.), Emory University School of Medicine, Atlanta, GA
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Yazan Duwayri
- Division of Vascular and Endovascular Therapy (Y.D.), Emory University School of Medicine, Atlanta, GA
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Haddad RN, Hascoet S, Karsenty C, Houeijeh A, Baruteau AE, Ovaert C, Valdeolmillos E, Jalal Z, Bonnet D, Malekzadeh-Milani S. Multicentre experience with Optimus balloon-expandable cobalt-chromium stents in congenital heart disease interventions. Open Heart 2023; 10:openhrt-2022-002157. [PMID: 36631173 PMCID: PMC9835936 DOI: 10.1136/openhrt-2022-002157] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To evaluate bare-metal Optimus and polytetrafluoroethylene (PTFE)-covered Optimus-CVS balloon-expandable, cobalt-chromium, hybrid cell-designed stents in congenital heart disease (CHD) interventions. METHODS Retrospective multicentre review of patients with CHD receiving Optimus stents. Stent mechanical behaviour, clinical indications and outcomes were assessed. RESULTS 183 stents (49.2% XXL/15-ZIG, 33.3% XL/12-ZIG, 17.5% L/9-ZIG) were implanted (98.9% success rate, 2.3% serious procedural complication rate) in 170 patients (57.6% men, 64.1% adults), median age 23.6 years (IQR, 15.2-39.2) and weight 63.5 kg (IQR, 47-75.7). Indications were right ventricular outflow tract stand-alone stenting or before revalvulation (62.4%), aortic coarctation treatment (15.3%), Fontan-circuit fenestration closure (12.4%) and miscellaneous (10%). 86/170 (50.6%) patients had PTFE-covered stenting (50% prophylactic). In 86/170 (50.6%) patients with stenotic lesions, median percentage of achieved stent expansion was 93.4% (IQR, 85.5%-97.7%), median gradient decreased from 28 mm Hg (IQR, 19-41) to 5 mm Hg (IQR, 1-9) (p<0.001), median vessel diameters increased from 13 mm (IQR, 7.9-17) to 18.9 mm (IQR, 15.2-22) (p<0.001) and percentage of vessel expansion was 45.2% (IQR, 19.8%-91.3%). In 30/36 (83.3%) patients with graft, median dilation of 2 mm (IQR, 2-5) above nominal diameter was achieved. Median stent shortening was 10.9% (IQR, 6.1-15.1) and was associated only with expansion diameter (OR: 0.66, 95% CI: 0.38 to 0.93). No clinically relevant fracture, stent embolisation or dysfunction occurred on a median follow-up of 9 (IQR, 4-14) months. CONCLUSIONS Optimus stents are effective tools for transcatheter treatment of simple and complex CHD. Optimus stents' reliable mechanical behaviour and particular covering design can promote widespread use.
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Affiliation(s)
- Raymond N Haddad
- Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker-Enfants malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France .,Department of Adult Congenital Heart Disease, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Sébastien Hascoet
- Department of Pediatric Cardiology and Congenital Heart Disease, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France
| | - Clément Karsenty
- Department of Pediatric and Adult Congenital Cardiology, Toulouse University Hospital, Clinique Pasteur, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France
| | - Ali Houeijeh
- Department of Pediatric Cardiology, Lille University Hospital, Lille, France
| | - Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, Nantes University Hospital, Nantes, France
| | - Caroline Ovaert
- Department of Pediatric Cardiology, Marseille University Hospital, Marseille, France
| | - Estibaliz Valdeolmillos
- Department of Pediatric Cardiology and Congenital Heart Disease, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France
| | - Zakaria Jalal
- Department of Pediatric Cardiology, Bordeaux University Hospital, IHU Lyric, Bordeaux, France
| | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker-Enfants malades, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France,Department of Adult Congenital Heart Disease, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France,Université de Paris Cité, Paris, France
| | - Sophie Malekzadeh-Milani
- Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker-Enfants malades, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France,Department of Adult Congenital Heart Disease, Hôpital Européen Georges-Pompidou, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France
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Shao Z, Song S, Han Y, Liang W, Fan T. First hybrid implantations of novel Salus-Valves in patients with severe pulmonary regurgitation: A case series. Front Cardiovasc Med 2022; 9:1059664. [PMID: 36505356 PMCID: PMC9729770 DOI: 10.3389/fcvm.2022.1059664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
With the increasing age of patients after right ventricular outflow tract (RVOT) reconstruction, progressive pulmonary valve (PV) dysfunction can result in different degrees of right heart insufficiency, and PV replacement is frequently needed during follow-up. The traditional redo thoracotomy is difficult and associated with higher risks when compared to transcatheter implantations. Herein, we report the advantages and describe the outcomes of the first hybrid implantations of the novel Salus-Valves (Balance Medical, Beijing, China) from the sub-xiphoid approach in five patients (mean age of 22.6 years) with severe pulmonary regurgitation (PR) after RVOT reconstruction.
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Affiliation(s)
- Zehua Shao
- Children’s Heart Center, Zhengzhou University People’s Hospital, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Shubo Song
- Children’s Heart Center, Zhengzhou University People’s Hospital, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Yu Han
- Department of Structural Cardiology, Zhengzhou University People’s Hospital, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital, Zhengzhou, China,*Correspondence: Yu Han,
| | - Weijie Liang
- Children’s Heart Center, Zhengzhou University People’s Hospital, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Taibing Fan
- Children’s Heart Center, Zhengzhou University People’s Hospital, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital, Zhengzhou, China,Taibing Fan,
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Haddad RN, Bonnet D, Gewillig M, Malekzadeh-Milani S. Modified safety techniques for transcatheter repair of superior sinus venosus defects with partial anomalous pulmonary venous drainage using a 100-mm Optimus-CVS® covered XXL stent. CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS : OFFICIAL JOURNAL OF THE SOCIETY FOR CARDIAC ANGIOGRAPHY & INTERVENTIONS 2022; 99:1558-1562. [PMID: 35192742 DOI: 10.1002/ccd.30136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 11/07/2022]
Abstract
We report the first use of a single 100-mm long custom-made version of the Optimus-CVS® balloon-expandable PTFE-covered XXL (15-Zig) stent (AndraTec, GmbH) to eliminate sinus venosus defect left-to-right shunt and redirect anomalous right pulmonary veins blood flow through a new walled channel to the left atrium. Anatomical feasibility and strategy decision were guided by ex-vivo procedure simulation on the patient-specific 3D printed heart model and in-vivo balloon interrogation. Modified procedural and implantation techniques are detailed. Immediate and one-month follow-up showed excellent outcomes.
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Affiliation(s)
- Raymond N Haddad
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.,Université de Paris, Paris, France
| | - Marc Gewillig
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France
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