Cracking the ring of Edwards Perimount bioprosthesis with ultrahigh pressure balloons prior to transcatheter valve in valve implantation

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

“…Controlled cracking of the polyester loop within the valve sewing ring using high‐pressure balloons has been described in vitro and in a small number of in vivo cases for surgical valves implanted in the pulmonary position40 with meaningful reductions in postprocedural gradient. In vitro, the frames of the Mitroflow, Magna, Magna Ease, and Mosaic,27 plus the Biocor Epic and Perimount40 bioprosthetic surgical valves have been successfully fractured using high‐pressure True Dilatation and Atlas Gold balloons (Bard Peripheral Vascular). Balloon‐rated burst pressure was exceeded in all cases and fracture of valves with metal sewing rings was not possible.…”

Transcatheter pulmonary valve replacement using the melody valve for treatment of dysfunctional surgical bioprostheses: A multicenter study

“…Unlike homografts or other RVOT conduits, stented BPVs have a fixed maximum diameter beyond which they cannot be expanded. Although cases have been reported in which the BPV ring has been fractured with an ultra-high-pressure balloon, 24,25 in general, the maximum internal diameter after valve-in-valve TPVR within a BPV will be several millimeters smaller than the nominal valve size, which typically reflects the outer diameter. Thus, in patients with a dysfunctional BPV in the pulmonary position, BPV size is a consideration when evaluating whether TPVR is a good option.…”

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

“…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.…”