First human implant of the Alterra Adaptive PrestentTM: A new self‐expanding device designed to remodel the right ventricular outflow tract

Figure 1. Schematic representation and photograph of the self‐expanding Alterra Adaptive Prestent. The distal and proximal flares aid in device stability. The uncovered distal row of cells allows for placement of the device into the orifice of the branch pulmonary arteries without causing obstruction to flow

Figure 2. Schematic representation and photographs of the Alterra delivery system in the uncovered (A,B) and covered (C) configurations. Turning the control wheel counter‐clockwise results in slow withdrawal of the retractable outer shaft and controlled expansion and delivery of the device.

Figure 3. Pre‐procedural evaluation. A, Three‐dimensional CT reconstruction of the right heart in systole and diastole used to calculate RVOT dimensions including lengths, diameters, and circumference along the length of the potential deployment zone. B, Virtual “implants” of an unconstrained, fully expanded device in systole and diastole examining the extent of device contact with vessel wall. C, Deployments of the device within a three‐dimensional soft rubber model of the RVOT. D, Still fluoroscopic frames of a test deployment using the same three‐dimensional model.

Figure 4. Implantation of the Alterra Adaptive Prestent and SAPIEN 3 valve. Top row, fluoroscopic images. Bottom row, intracardiac echocardiographic images (ICE). A, Right ventricular angiogram with the device in position prior to deployment. B, Following deployment of the Alterra and removal of the delivery system, a pulmonary angiogram demonstrates free pulmonary regurgitation with good apposition of the device to the vessel wall as also seen on the corresponding ICE image (D). C, Pulmonary angiogram following delivery of the SAPIEN 3 demonstrating excellent valve function with trivial pulmonary regurgitation, corresponding to the ICE image below (E).