Cracking a tricuspid perimount bioprosthesis to optimize a second transcatheter sapien valve‐in‐valve placement

Abstract

Bioprosthetic valves degenerate over time. Transcatheter valve-in-valve procedures have become an attractive alternative to surgery. However, every valve increasingly diminishes the diameter of the valvar orifice. We report a 12-year-old female who had a previous transcatheter tricuspid valve-in-valve procedure; cracking the ring of a Carpentier Edwards Perimount valve by means of an ultrahigh pressure balloon allowed implantation of a further larger percutaneous valve. The advantage of this novel approach permits enlarging the inner valve diameter and may facilitate future interventions and prolong time to surgery. © 2016 Wiley Periodicals, Inc.

Implante percutáneo de válvula aórtica sobre válvula protésica estenótica valve in valve con técnica de cracking: primer reporte de un caso en Argentina

“…Sin embargo, cuando las válvulas aórticas protésicas son pequeñas y como en este caso se asocian a un anillo metálico inexpandible dado por el hecho de que el tejido biológico está suturado a un stent metálico.La expansión completa de la nueva válvula, si esta es implantada percutáneamente, es muy difícil que se logre; de ahí que en muchos casos quedan con gradientes residuales altos 11 . En la literatura, se han reportado casos aislados de técnica de cracking durante implantes percutáneos de válvulas pulmonar, tricúspide y aórtica [11][12][13] con la fi nalidad de incrementar el diámetro interno del anillo valvular y así lograr un área efectiva del orifi cio valvular más grande en la nueva válvula implantada. La primera descripción fue realizada por Tanase et al 11 en el 2014 en 3 casos de estenosis de válvula pulmonar protésica, en los que se utilizaron balones de 20 mm de diámetro y se pudo lograr un área valvular efectiva de 22 mm.…”

Fracturing a dysfunctional Edwards Perimount bioprosthetic valve to facilitate percutaneous valve‐in‐valve placement of SAPIEN 3 valve with modified delivery system

“…The ability to crack BPVs allows for larger VIV diameters, which should optimize hemodynamics. Cracking Perimount bioprostheses with high‐pressure balloons was first described by Tanase et al . They performed bench testing with high‐pressure balloon dilation of the Perimount valve and showed that at high atmospheres there was loss of integrity of the Elgiloy band without destruction of the surrounding Dacron sewing ring.…”

“…Repeat coronary angiography during dilation with the 20–4 Atlas Gold balloon showed no extrinsic compression of the coronaries. Repeat hemodynamics revealed no change in the gradient across the valve, so we decided to dilate the Perimount valve with a larger diameter balloon with the intention of fracturing the Elgiloy band as previously described in the literature . The 21‐mm Perimount style valves have a true internal dimension of 19 mm, so we serially dilated with 22–4 and 24–4 Atlas Gold balloons.…”

Transhepatic implant of a trimmed Melody™ valved stent in tricuspid position in a 1‐year‐old infant

“…When tricuspid valve dysfunction occurs, reinsertion of a new valve can be possible but first the frame of the Epic valve has to be cracked in order to increase the inner diameter prior implantation of a new bioprosthetic valve percutaneously. Cracking the frame is possible as described by Brown et al .…”