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Jochen Cremer
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Ann Thorac Surg 2006;82:708-713
© 2006 The Society of Thoracic Surgeons

New technology

Percutaneous Pulmonary Valve Replacement: 3-Month Evaluation of Self-Expanding Valved Stents

Tim Attmann, MDa, René Quaden, MDa, Thomas Jahnke, MD, PhDb, Stefan Muller-Hulsbeck, MD, PhDb, Andreas Boening, MD, PhDa, Jochen Cremer, MD, PhDa, Georg Lutter, MD, PhDa,*

a Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Kiel, Germany
b Department of Radiology, Christian-Albrechts-University of Kiel, School of Medicine, Kiel, Germany

Accepted for publication January 26, 2006.

* Address correspondence to Dr Lutter, Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 7, Kiel, 24105 Germany (Email: lutter{at}kielheart.uni-kiel.de).

PURPOSE: In a recent study our group established an acute animal model of percutaneous pulmonary valve replacement using self-expanding nitinol stents. The present study was performed to evaluate these valved stents over a 3-month period.

DESCRIPTION: Bovine jugular xenografts were sutured into nitinol stents. Transfemoral implantation in the pulmonary position using a modified commercially available application device (with a 22-French outer diameter) was evaluated in 9 sheep.

EVALUATION: Two sheep died shortly after successful valved stent implantation due to internal venous hemorrhage. Another 1 sheep died 2.5 months after the procedure due to vegetations on the neovalve leading to subtotal stenosis. All other animals survived the 3-month study time (n = 6). An orthotopic pulmonary valved stent position was achieved in 4 animals and a supravalvular position in 1. During the deployment procedure, rhythm disturbances occurred in all animals, and mean arterial blood pressure dropped from 83.9 ± 26.0 mm Hg to 68.3 ± 22.3 mm Hg (p = 0.006) (n = 5). The peak-to-peak transvalvular gradient was 5.1 ± 4.0 mm Hg initially (n = 5), and 3.6 ± 1.6 mm Hg at follow-up (n = 5). Three-month angiographic and echocardiographic follow-up confirmed competent neovalves without paravalvular leakages.

CONCLUSIONS: After 3 months of implantation, percutaneously implanted memory nitinol valved stents demonstrated good function in the sheep.




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