Transcatheter Implantation of a Bovine Valve in Pulmonary Position

Abstract

Background-Pulmonary regurgitation can lead to severe right ventricular dysfunction, which is a delicate postoperative problem in the long-term follow-up of patients who had surgery for congenital heart diseases. Clinical conditions of patients suffering from pulmonary valve incompetence are improved by valve replacement with a prosthetic valve. To date, the surgical approach is the only option to replace a pulmonary valve. We report the first experience of percutaneous pulmonary valve implantation. Methods and Results-A fresh bovine jugular vein containing a native valve was sutured into a vascular stent and then cross-linked with a 0.6% glutaraldehyde solution for 36 hours. After being hand-crimped onto a balloon catheter, the device was inserted percutaneously according to standard stent-placing techniques. The valved stent was finally deployed in the position of the native pulmonary valve of the lamb. Hemodynamic evaluation was carried out before and 2 months after implantation. Anatomic evaluation was finally performed. Percutaneous pulmonary valve replacement was successful in 5 lambs. No complications were noted. Early and late angiographic and hemodynamic studies confirmed a good position of the stents with a competent valve at the end of the protocol. One stent was slightly stenotic, with macroscopically visible calcifications. Conclusions-Nonsurgical implantation of pulmonary valves is possible in the lamb. This new technique is similar to standard stent implantation. Thus, it should be feasible in humans, in whom it will lead to a significant reduction of reoperations in patients in need of pulmonary valve replacement. (Circulation. 2000;102:813-816.)

Differential Regurgitation in Branch Pulmonary Arteries After Repair of Tetralogy of Fallot

“…An intriguing additional therapeutic option may exist in those patients in whom pulmonary regurgitation is predominantly from 1 pulmonary artery. Insertion of a valved stent 26 in the LPA might be expected to reduce total regurgitation by up to 100% in some patients and may be a particularly attractive option in those patients with a grossly dilated right ventricular outflow tract, who would otherwise be unsuitable for implantation of an existing valved stent in the MPA.…”

NuMED covered cheatham‐platinum stent™ for the treatment or prevention of right ventricular outflow tract conduit disruption during transcatheter pulmonary valve replacement

“…While resolving the problem of conduit obstruction, bare stent placement leads to creation or exacerbation of pulmonary regurgitation. To overcome this problem, Bonhoeffer et al reported the first transcatheter pulmonary valve replacement (TPVR) in 2000 using a biological valve harvested from a bovine jugular vein (Medtronic, Minneapolis, MN) and sewn within a balloon-expandable Cheatham Platinum Stent (NuMED, Hopkinton, NY) [2,3].…”

Transcatheter Pulmonary Valve Replacement

“…Four of the valves were mobile and competent with slight stenosis secondary to visible calcification in the fifth one. Although the overall success rate was low at about 36%, these attempts provided the platform for human studies [11].…”