Our Summary

The research paper is about a study conducted on the use of a particular type of artificial heart valve - the Edwards SAPIEN S3 valve - in a heart procedure without using a pre-stent. A pre-stent is a small tube usually inserted into a blocked passageway to keep it open, and the Edwards SAPIEN S3 valve is a type of artificial heart valve that is usually inserted into the heart to replace a damaged one.

The valve was used to replace the pulmonary valve in patients with congenital heart disease and dysfunctional right ventricular outflow tracts (RVOTs). The pulmonary valve is a part of the heart that prevents blood from flowing back into the lower right chamber of the heart once it’s been pumped out. A dysfunctional RVOT means the passage through which blood leaves the heart is not working properly.

The study found that the valve could be successfully inserted without the use of a pre-stent. There were no cases where the valve couldn’t be implanted or where it got dislodged or misplaced. After a follow-up period of between 1 month and over 2 years, none of the patients had significant issues around the valve. There were no fractures in the valve frame and no deaths related to the procedure.

However, there were some major complications including severe aortic compression and damage to the tricuspid valve that required surgical intervention. The research team concluded that the SAPIEN valve can be used without a pre-stent for this procedure, but more long-term follow-up is needed to fully understand this method.

FAQs

  1. What is a percutaneous transcatheter pulmonary valve replacement (TPVR)?
  2. What were the results of the study on TPVR using the SAPIEN S3 valve without pre-stenting?
  3. What are the potential complications of TPVR using the SAPIEN valve without the use of a pre-stent?

Doctor’s Tip

A doctor may tell a patient undergoing pulmonary valve replacement using the Edwards SAPIEN S3 valve without pre-stenting that the procedure has shown promising results in terms of safety and efficacy in the short to medium term. It is important for the patient to follow up regularly with their healthcare provider to monitor for any potential complications and ensure long-term success of the valve replacement. Additionally, the patient should be aware of any potential risks such as aortic compression or tricuspid valve injury, and should seek immediate medical attention if they experience any concerning symptoms.

Suitable For

Patients who are typically recommended for pulmonary valve replacement include those with congenital heart disease and dysfunctional right ventricular outflow tracts, including those with native RVOTs, conduits, and bioprosthetic valves. Patients with significant obstruction or regurgitation around the valve may also be candidates for pulmonary valve replacement. In this study, the Edwards SAPIEN S3 valve was successfully implanted without the use of a pre-stent, demonstrating promising short and intermediate-term results. Longer term follow-up is needed to fully evaluate the effectiveness of this method.

Timeline

Timeline of patient experience before and after pulmonary valve replacement:

Before TPVR:

  1. Initial evaluation and diagnosis of dysfunctional RVOT
  2. Consultation with a cardiologist and cardiac surgeon
  3. Pre-operative testing and imaging (echocardiogram, MRI, etc.)
  4. Discussion of treatment options, including TPVR
  5. Scheduling of TPVR procedure

During TPVR:

  1. Placement of the SAPIEN valve in the pulmonary position without pre-stenting
  2. Monitoring of vital signs and hemodynamics during the procedure
  3. Post-procedural imaging to assess valve placement and function
  4. Recovery in the hospital for a few days for monitoring and management of any complications

After TPVR:

  1. Follow-up appointments with the cardiologist to monitor valve function and overall cardiac health
  2. Continued monitoring with imaging studies to assess valve function and potential complications
  3. Adjustment of medications as needed to manage any residual symptoms or complications
  4. Long-term follow-up to assess the durability and effectiveness of the TPVR procedure

Overall, the patient can expect a gradual improvement in symptoms such as shortness of breath, fatigue, and exercise intolerance following successful TPVR. Regular follow-up appointments and monitoring are essential to ensure the long-term success of the procedure.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with pulmonary valve replacement using the Edwards SAPIEN S3 valve without pre-stenting?
  2. How long can the SAPIEN valve be expected to last in the pulmonary position?
  3. Will I need to undergo any additional procedures or interventions in the future after the pulmonary valve replacement?
  4. How often will I need follow-up appointments and imaging studies to monitor the function of the replaced pulmonary valve?
  5. Are there any specific lifestyle modifications or restrictions I should be aware of after undergoing pulmonary valve replacement?
  6. Will I need to take any medications long-term after the procedure?
  7. What signs or symptoms should I watch out for that may indicate a complication or problem with the replaced pulmonary valve?
  8. How experienced is the medical team in performing percutaneous transcatheter pulmonary valve replacement without pre-stenting?
  9. Are there any alternative treatment options for my specific condition that I should consider before proceeding with pulmonary valve replacement?
  10. What is the expected recovery time and rehabilitation process after pulmonary valve replacement surgery?

Reference

Authors: Morgan GJ, Sadeghi S, Salem MM, Wilson N, Kay J, Rothman A, Galindo A, Martin MH, Gray R, Ross M, Aboulhosn JA, Levi DS. Journal: Catheter Cardiovasc Interv. 2019 Feb 1;93(2):324-329. doi: 10.1002/ccd.27932. Epub 2018 Oct 23. PMID: 30351525