Page 34 - Journal of Structural Heart Disease Volume 1, Issue 3

Original Scientific Article 140
Figure 2. Implantation of a valved stent in large tricuspid annulus. Creation of a platform. The platform is created using the property of 2 different stents used simultaneously with one fitted within the second one: 1/ a bare metal stent with limited expansion (typically short EV3 LD mega) allows a restrictive region for subsequent valve insertion; 2/ a covered stent without limited expansion (typically long covered CP stent) allows anchoring to the large surgically inserted bioprosthesis. Top left. EV3LD mega is mounted on a long covered CP stent over a balloon. The balloon is being inflated. Top right. in vitro aspect after deflation and retrieval of the balloon catheter. The stent assembly has now the aspect of a Dumbbell stent creating a perfect platfrom for a valved stent. Below/left. front view of the stent assembly within a bioprosthetic surgical valve. The extremities of the stent assembly are holding on the frame of the bioprosthetic valve. Below/right. axial view of the stent assembly within a bioprosthetic surgical valve. 2 different diameters are shown. The middle part is smaller than the extremities. This middle part will hold the valved stent to be implanted.
gitation in 5. The valve was successfully placed in all patients via the femoral vein in 11 and the internal jugular vein in 4 patients. Pre-dilation or low-pressure balloon sizing was performed in four patients be- fore valve implantation while pre-stenting was not described. Post-implantation dilation using high- pressure balloons was performed in seven patients. The median post-procedure tricuspid gradient was 2 mm Hg and no patient had more than mild regurgi- tation. After a median follow-up of four months, 14 of 15 patients who underwent the Melody valve implan- tation are alive and well. Complications included one
death in a patient with pre-procedural multi-organ failure, one with third-degree heart block requiring pacemaker implantation, and one case of endocarditis requiring valve removal 2 months after implantation.
Recently, a similar case series reporting percuta- neous implantation of the Melody valve within failed mitral (n=10) and tricuspid (n=9) bioprosthetic valves was published [23]. Among tricuspid patients (mean age 42 ± 24 years), mean transvalvular gradient was 10 ± 4.3 mm Hg among and seven patients had mod- erate or worse tricuspid valve regurgitation. Imaging was performed with intracardiac echocardiography
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 3: 137-151