Department of Pediatrics, Charles E. Mullins Cardiac Catheterization Laboratories, Texas Children's Hospital, and Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
Catheter Cardiovasc Interv. 2020 Nov;96(6):1287-1293. doi: 10.1002/ccd.29120. Epub 2020 Jun 30.
Tricuspid valve injury can occur during implantation of a SAPIEN valve in the pulmonary position. We describe our experience using a long Gore DrySeal (GDS) sheath to protect the tricuspid valve during advancement of the Commander delivery system.
Retrospective single center review of all patients who underwent placement of a SAPIEN valve in the right ventricular outflow tract between January 2016 and April 2020. Patients were divided into two groups: delivery of the valve using standard technique (Group I), and with the use of a GDS (Group II), for comparison.
There were 48 patients in total: 25 in Group I and 23 in Group II. In Group II, the first 10 patients had a 29 mm S3 placed through a 26 French (Fr), 65 cm GDS. We then performed additional crimping of the S3 onto the balloon after the balloon catheter was withdrawn to position the valve on the balloon outside the body. Subsequently, seven had a 29 mm S3 placed through a 24 Fr GDS, and four had a 26 mm S3 placed through a 22 Fr GDS including one weighing 16 kg. Two had a 23 mm S3 placed through a 22Fr GDS as the 20Fr GDS was not available in our lab. Severe tricuspid valve injury occurred in 2/25 (8%) of Group I patients and 0/23 of Group II patients.
Use of a long GDS may protect the tricuspid valve from injury during implantation of the S3 valve in the pulmonary position, and is technically feasible in smaller patients.
在肺动脉位置植入 SAPIEN 瓣膜时可能会损伤三尖瓣。我们描述了在推进 Commander 输送系统时使用长 Gore DrySeal（GDS）护套保护三尖瓣的经验。
回顾性分析 2016 年 1 月至 2020 年 4 月期间在右心室流出道植入 SAPIEN 瓣膜的所有患者。患者分为两组：使用标准技术输送瓣膜（I 组）和使用 GDS（II 组）进行比较。
共有 48 例患者：I 组 25 例，II 组 23 例。在 II 组中，前 10 例患者通过 26 Fr、65 cm GDS 放置了 29mm S3。然后，我们在球囊导管撤回后对 S3 进行额外的球囊压缩，以将瓣膜定位在体外的球囊上。随后，7 例通过 24 Fr GDS 放置了 29mm S3，4 例通过 22 Fr GDS 放置了 26mm S3，其中包括 1 例体重为 16kg。由于实验室中没有 20Fr GDS，2 例患者通过 22Fr GDS 放置了 23mm S3。I 组患者中有 2/25（8%）和 II 组患者中无 0/23 例患者发生严重三尖瓣损伤。
使用长 GDS 可在肺动脉位置植入 S3 瓣膜时保护三尖瓣免受损伤，并且在较小的患者中技术上是可行的。
