The Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture prior to valve-in-valve transcatheter pulmonary valve replacement in a child

Q: What are the key findings of this study?

Staged Y-stenting and bioprosthetic valve frame fracture prior to valve-in-valve TPVR reduced the pulmonary stenosis gradient from 51 to 30 mm Hg and the RV/LV ratio from 0.73 to 0.39.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Supravalvular pulmonary stenosis, pulmonary artery bifurcation stenosis, and bioprosthetic valve dysfunction after Tetralogy of Fallot repair (n=1). Intervention: Staged Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture with a 24 mm Atlas balloon at 18 atm followed by 23 mm Edwards Sapien XT valve-in-valve transcatheter pulmonary valve replacement. Primary outcome: Residual pulmonary stenosis gradient and right-to-left ventricle pressure ratio (RV/LV).

Q: What does this research mean for the field?

Staged Y-stenting and intentional bioprosthetic valve frame fracture prior to valve-in-valve transcatheter pulmonary valve replacement successfully relieves pulmonary bifurcation stenosis, reducing the transvalvular gradient and right-to-left ventricle pressure ratio. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Michał Gałeczka; Sebastian Smerdziński; W Sadowski; Marcin Demkow; Jacek Białkowski; Roland Fiszer

doi:10.5114/aic.2020.96066

January 1, 2020Advances in Interventional CardiologyOpen Access

The Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture prior to valve-in-valve transcatheter pulmonary valve replacement in a child

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Key result

Staged Y-stenting and bioprosthetic frame fracture before TPVR cuts pulmonary stenosis gradient by ~21 mm Hg.

n=1

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Key Points

To evaluate the feasibility and safety of staged Y-stenting and intentional bioprosthetic valve frame fracture to resolve bifurcation and supravalvular stenosis prior to valve-in-valve transcatheter pulmonary valve replacement.
Conducted a staged interventional procedure in a 17-year-old male (69 kg) with repaired Tetralogy of Fallot and a failing 23 mm Carpentier-Edwards Perimount Magna bioprosthetic valve presenting with severe pulmonary stenosis.
Utilized preprocedural 3D CT-derived silicone modeling to simulate stent deployment and bench test valve frame cracking at 14 atm using a 24 mm Atlas balloon.
Carried out staged stenting of the left pulmonary artery and pulmonary trunk (48 mm AndraStent XXL), followed one month later by right pulmonary artery stenting (21 mm AndraStent XXL), and three months later by bioprosthetic valve fracture at 18 atm and 23 mm Edwards Sapien XT valve implantation.
Bioprosthetic valve frame fractured successfully at 18 atm, expanding the inner diameter from 19 mm to 24 mm, while widening the right pulmonary artery to 11.4 mm, the left pulmonary artery to 16 mm, and the supravalvular narrowing to 21 mm.
The pulmonary stenosis gradient decreased from 51 mm Hg to a residual gradient of 30 mm Hg, with the right-to-left ventricle pressure ratio dropping from 0.73 to 0.39 and no procedure-related complications.
At 10-month follow-up, the patient remained asymptomatic with a mean pulmonary stenosis gradient < 25 mm Hg and no pulmonary regurgitation on control echocardiography.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 17-year-old asymptomatic boy (n=1, 69 kg) with repaired Tetralogy of Fallot, bioprosthetic pulmonary valve dysfunction, supravalvular pulmonary stenosis, and pulmonary artery bifurcation stenosis, followed for 10 months.

I

Intervention

Staged transcatheter intervention consisting of Y-stenting technique for bifurcation stenosis (48 mm AndraStent XXL on a 22 mm BIB balloon into the LPA, pulmonary trunk, and Magna valve; followed 1 month later by a 21 mm AndraStent XXL on a 16 mm MaxiLD balloon into the RPA), intentional fracture of the 23 mm Magna bioprosthetic valve frame 3 months later using a 24 mm Atlas ultra-high-pressure balloon at 18 atm, and subsequent valve-in-valve transcatheter pulmonary valve replacement (TPVR) with an overdilated 23 mm Edwards Sapien XT valve (plus life-long aspirin and 6 months of clopidogrel).

O

Outcome

Hemodynamic and anatomic relief of right ventricular outflow tract and pulmonary artery bifurcation obstruction (residual pulmonary stenosis gradient, RV/LV pressure ratio, and vessel/valve internal diameters) immediately post-procedure and at 10-month follow-up.surrogate

Limitations

Single-patient case report

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Implication

Staged Y-stenting for pulmonary artery bifurcation stenosis combined with ultra-high-pressure balloon fracture of a surgical bioprosthetic valve frame is a feasible transcatheter strategy prior to valve-in-valve TPVR to avoid high-risk reoperation in complex congenital heart disease.

Abstract

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Gałeczka M, Smerdziński S, Sadowski W, Demkow M, Białkowski J, Fiszer R. The Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture prior to valve-in-valve transcatheter pulmonary valve replacement in a child. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2020;16(2):206-208. doi:10.5114/aic.2020.96066. APA Gałeczka, M., Smerdziński, S., Sadowski, W., Demkow, M., Białkowski, J., & Fiszer, R. (2020). The Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture prior to valve-in-valve transcatheter pulmonary valve replacement in a child. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 16(2), 206-208. https://doi.org/10.5114/aic.2020.96066 Chicago Gałeczka, Michał, Sebastian Smerdziński, Wojciech Sadowski, Marcin Demkow, Jacek Białkowski, and Roland Fiszer. 2020. "The Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture prior to valve-in-valve transcatheter pulmonary valve replacement in a child". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 16 (2): 206-208. doi:10.5114/aic.2020.96066. Harvard Gałeczka, M., Smerdziński, S., Sadowski, W., Demkow, M., Białkowski, J., and Fiszer, R. (2020). The Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture prior to valve-in-valve transcatheter pulmonary valve replacement in a child. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 16(2), pp.206-208. https://doi.org/10.5114/aic.2020.96066 MLA Gałeczka, Michał et al. "The Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture prior to valve-in-valve transcatheter pulmonary valve replacement in a child." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 16, no. 2, 2020, pp. 206-208. doi:10.5114/aic.2020.96066. Vancouver Gałeczka M, Smerdziński S, Sadowski W, Demkow M, Białkowski J, Fiszer R. The Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture prior to valve-in-valve transcatheter pulmonary valve replacement in a child. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2020;16(2):206-208. doi:10.5114/aic.2020.96066.

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Cite This Study

Gałeczka et al. (2020) conducted a case report in Supravalvular pulmonary stenosis, pulmonary artery bifurcation stenosis, and bioprosthetic valve dysfunction after Tetralogy of Fallot repair (n=1). Staged Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture with a 24 mm Atlas balloon at 18 atm followed by 23 mm Edwards Sapien XT valve-in-valve transcatheter pulmonary valve replacement was evaluated on Residual pulmonary stenosis gradient and right-to-left ventricle pressure ratio (RV/LV). Staged Y-stenting and bioprosthetic valve frame fracture prior to valve-in-valve TPVR reduced the pulmonary stenosis gradient from 51 to 30 mm Hg and the RV/LV ratio from 0.73 to 0.39.

synapsesocial.com/papers/6a7a5752b008f0cadf325ed5 https://doi.org/10.5114/aic.2020.96066

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The Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture prior to valve-in-valve transcatheter pulmonary valve replacement in a child

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture prior to valve-in-valve transcatheter pulmonary valve replacement in a child

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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