Key result
Use of a long Gore DrySeal sheath during SAPIEN valve implantation in the pulmonary position resulted in 0% severe tricuspid valve injury compared to 8% with standard technique.
Why the study?
Tricuspid valve injury can occur during implantation of a SAPIEN valve in the pulmonary position, prompting evaluation of a long Gore DrySeal sheath to protect the valve.
Does the use of a long Gore DrySeal sheath prevent severe tricuspid valve injury during SAPIEN valve implantation in the pulmonary position?
Cohort (n=48)
No
Does the use of a long Gore DrySeal sheath prevent severe tricuspid valve injury during SAPIEN valve implantation in the pulmonary position?
Using a long Gore DrySeal sheath during SAPIEN valve implantation in the pulmonary position may protect against severe tricuspid valve injury.
Answers are grounded in this paper and cite their sources.
May lower severe tricuspid injury risk during pulmonary SAPIEN implantation; hypothesis-generating and requires prospective confirmation before practice change.
BACKGROUND: Tricuspid valve injury can occur during implantation of a SAPIEN valve in the pulmonary position. We describe our experience using a long Gore DrySeal (GDS) sheath to protect the tricuspid valve during advancement of the Commander delivery system. METHODS: Retrospective single center review of all patients who underwent placement of a SAPIEN valve in the right ventricular outflow tract between January 2016 and April 2020. Patients were divided into two groups: delivery of the valve using standard technique (Group I), and with the use of a GDS (Group II), for comparison. RESULTS: There were 48 patients in total: 25 in Group I and 23 in Group II. In Group II, the first 10 patients had a 29 mm S3 placed through a 26 French (Fr), 65 cm GDS. We then performed additional crimping of the S3 onto the balloon after the balloon catheter was withdrawn to position the valve on the balloon outside the body. Subsequently, seven had a 29 mm S3 placed through a 24 Fr GDS, and four had a 26 mm S3 placed through a 22 Fr GDS including one weighing 16 kg. Two had a 23 mm S3 placed through a 22Fr GDS as the 20Fr GDS was not available in our lab. Severe tricuspid valve injury occurred in 2/25 (8%) of Group I patients and 0/23 of Group II patients. CONCLUSION: Use of a long GDS may protect the tricuspid valve from injury during implantation of the S3 valve in the pulmonary position, and is technically feasible in smaller patients.
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Stapleton et al. (2020) conducted a cohort in Placement of a SAPIEN valve in the right ventricular outflow tract (n=48). Gore DrySeal (GDS) sheath vs. Standard technique was evaluated on Severe tricuspid valve injury. Use of a long Gore DrySeal sheath during SAPIEN valve implantation in the pulmonary position resulted in 0% severe tricuspid valve injury compared to 8% with standard technique.
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