Page 9 - Journal of Structural Heart Disease Volume 3, Issue 3

Review Article
Journal of Structural Heart Disease, June 2017, Volume 3, Issue 3: 62-72
DOI: http://dx.doi.org/10.12945/j.jshd.2017.016.14
Received: December 23, 2014 Accepted: September 15, 2016 Published online: June 2017
Transcatheter Pulmonary Valve Replacement
The Edwards Sapien Valve
Joseph DeGiovanni, MD, FRCP, FRCPCH*
Department of Cardiology, Children’s & Queen Elizabeth Hospitals, Birmingham, UK
Abstract
intensive care, and results in a shorter hospital stay. Cost e ectiveness is comparable, and because the Ed- wards valve is based on a well-established tissue valve technology, its longevity are performance are expected to be similar to that of surgery as the frame on which the valve is mounted is very robust with complete integrity maintained over at least 5 years from implantation. Copyright © 2017 Science International Corp.
Key Words:
Sapien • Edwards valve • Pulmonary valve replacement • Catheter intervention
Equipment
This consists of the Edwards valve itself, a dilator kit, introducer sheaths, balloon catheter, delivery system and the Atrion in ation device. In addition, diagnostic catheters, various balloons, guide wires, snares, and stents should be available.
Edwards Equipment
The Sapien Edwards valve, which comes in the Sa- pien XT and Sapien 3 versions, is balloon expandable and fashioned from bovine pericardium similar to tis- sue that has been used for surgical tissue valves for many years. Bovine pericardium consists of densely layered collagen and has clinically proven long-term durability. The bovine pericardium is carefully inspect- ed and chosen for uniform thickness and quality. The
*Corresponding Author:
Joseph DeGiovanni, MD, FRCP, FRCPCH
Children’s & Queen Elizabeth Hospitals
Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK Tel.: +0044 777 575 1991; Fax: +0044 121 681 2442; E-Mail: degiovanni@blueyonder.co.uk
Pulmonary valve replacement is one of the most com- mon surgical procedures performed in older children and adults with congenital heart disease who have normally had at least one previous operation. The per- cutaneous alternative was rst performed in man in 2000 when Dr. Bonhoe er merged a surgically avail- able bovine jugular vein valve (Venpro/Contegra) and a Cheatham-Platinum (CP) stent to create a percuta- neous system for stenosed conduits; this valve was subsequently acquired by Medtronic and is now the Melody valve. The Edwards Sapien valve was original- ly designed for percutaneous aortic valve replacement (TAVI/TAVR), but its design makes it equally suitable for pulmonary implantation using a similar delivery sys- tem and it is indeed indicated for this purpose [1, 2]. The Edwards valve has evolved over recent years, increasing the range of sizes including the 29-mm Edwards XT and, more recently, the Sapien 53. The Edwards 3, incorpo- rates a cu /skirt outside of the frame to minimize para- valvular leaks; it was primarily designed for the aortic position where paravalvular leaks are generally more signi cant. Follow-up observations indicate that the performance and longevity of the Edwards percutane- ous valve are comparable to surgically implanted bio- prostheses which are also manufactured by Edwards Lifesciences; the catheter technique has reached a high level of sophistication to achieve successful and safe results in selected individuals. Some patients, however, would be better candidates for surgery, usually for an- atomic reasons.
Transcatheter pulmonary valve implantation has some advantages over surgery, as it is less invasive, avoids re- peat sternotomy and bypass, does not usually require
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