Modified technique of percutaneous pulmonary valve implantation with the Sapien 3: Impact on procedure and early outcome

Introduction Percutaneous pulmonary valve implantation (PPVI) with Sapien 3 valve is effective to treat right ventricle outflow (RVOT) dysfunction. Issues related to presenting and tricuspid valve injuries were reported with the initial implantation method. A modified technique was developed without pre-stenting and with a protective delivery method for valve implantation. Methods We aimed to compare procedural results in the modified technique group (MTG) to matched patients in a conventional technique group (CTG). All consecutive procedures performed in the MTG over 9 months were matched based on RVOT type and size to consecutive procedures performed before. Results Twenty-seven patients were included in each group. Size of the Sapien 3 valves were 23 mm (n = 9), 26 mm (n = 9), 29 mm (n = 36). The two groups were similar regarding demographic data, RVOT type, pre-procedure hemodynamics ( Table 1 ). PPVI was performed in a single procedure in all patients of the MTG, whereas six (22.2%) patients of the CTG group had pre-stenting as a first step and valve implantation later (P = 0.02). Procedures were successful in all cases. Stent embolization was reported in two patients (7.4%) in the CTG, which were impacted in pulmonary arteries. Instability of a valve was observed in one case (3.7%) in the MTG, stabilized with two stents and an additional valve-in-valve implantation. Hemodynamics results were good in all cases without significant difference among the two groups ( Table 2 ). Procedure duration and fluoroscopy times were significantly reduced in the MTG (48.1 versus 82.6 minutes, P  During follow-up, no stent fracture or valve dysfunction was noticed in both groups. Conclusion PPVI without pre-stenting and with a protective delivery method of the Sapien 3 valve reduces significantly the procedure complexity, procedure duration and irradiation, while maintaining excellent hemodynamics results.