Experimental off-pump transventricular pulmonary valve replacement using a self-expandable valved stent: A new approach for pulmonary incompetence after repaired tetralogy of Fallot?
| Autor: | A. Ung, Fabrice Wautot, François Godart, Christian Rey, André Vincentelli, Brigitte Jude, Delphine Corseaux, Francis Juthier, A. Prat, Ivan Bouzguenda |
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| Rok vydání: | 2009 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty medicine.medical_treatment Heart Valve Diseases Pulmonary insufficiency Prosthesis Design Risk Assessment Sensitivity and Specificity Pulmonary artery banding Valve replacement Pulmonary Valve Replacement Internal medicine medicine Animals Heart valve Pliability Tetralogy of Fallot Heart Valve Prosthesis Implantation Pulmonary Valve Cardiopulmonary Bypass Sheep business.industry Stent medicine.disease Prosthesis Failure Surgery Survival Rate Disease Models Animal Treatment Outcome medicine.anatomical_structure Echocardiography Heart Valve Prosthesis Pulmonary valve Cardiology Stents Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 137:1141-1145 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2008.07.057 |
| Popis: | Objective Off-pump valve replacement using self-expandable stents is an emerging technique for pulmonary valve disease. However, significant limitations are the lack of easily available valve substitute to be inserted within the stent and, in the setting of repaired tetralogy of Fallot, the existence of huge pulmonary trunk. We report the first experimental results of a transventricular approach using a decellularized porcine xenograft mounted in a self-expandable stent. Methods Pulmonary valve replacement was realized in 15 lambs by direct access of the infundibulum through a left thoracotomy, combined with pulmonary artery banding. Animals were followed by transthoracic echocardiography and, after control hemodynamic study, were electively killed either at day 7, month 1, or month 4 after implantation. Results Implantation succeeded in all lambs. Two animals died after implantation (1 pneumothorax and 1 endocarditis). Doppler echocardiographic follow-up did not show any significant transvalvular gradient and showed only mild pulmonary regurgitation. The hemodynamic control before termination revealed a systolic pulmonary valve gradient of 18.5 ± 12.4 mm Hg at 1 week (n = 4), 13.5 ± 10.6 mm Hg at 1 month (n = 4), and 4.3 ± 4.9 mm Hg at 4 months (n = 5). Gross examination demonstrated the presence of connective tissue between the valved stent and pulmonary wall, which increased with time. Conclusion Fifteen lambs underwent successful deployment of a self-expandable valved stent in the pulmonary position using a transventricular approach. This technique combined with pulmonary artery banding could be a therapeutic option for pulmonary insufficiency after repair of tetralogy of Fallot with a transannular patch. |
| Databáze: | OpenAIRE |
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