Skip to main content
SpringerLink
Log in

Percutaneous Pulmonary Valve Implantation: The First Transcatheter Valve

  • Chapter
  • First Online:
Heart Valves

Abstract

Percutaneous pulmonary valve implantation (PPVI) is an innovative, successful alternative to open-heart surgery for the treatment of pulmonary valve dysfunction. However, the current device used in PPVI presents some limitations: stent fractures and availability to a limited group of patients with very specific anatomy. These shortcomings have created the need for a new device that can significantly broaden the number of patients that might benefit from this minimally invasive procedure. In this chapter, we show how engineering methodologies, such as patient-specific 3D imaging elaboration and finite element modeling, were adopted to study the current PPVI device limitations and a new design for the next generation device. These techniques were successfully implemented in the first-in-man application of this new device. The presented combined strategy has the potential to aid and accelerate the design of future percutaneous heart valve devices, and also to contribute to shorter learning curves for patient selection and lower numbers of procedural and device failures, thus enhancing patient safety.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

Bib:

Balloon-in-balloon

CT:

Computed tomography

ECG:

Electrocardiogram

FDA:

Food and Drug Administration

FE:

Finite element

HDE:

Humanitarian Device Exemption

MHRA:

Medicines and Healthcare Products Regulatory Agency

MR:

Magnetic resonance

PPVI:

Percutaneous pulmonary valve implantation

PVR:

Pulmonary valve replacement

RVOT:

Right ventricular outflow tract

SG1:

First stent-graft

SG2:

Second stent-graft

SG3:

Third stent-graft

References

  1. Marelli AJ, Mackie AS, Ionescu-Ittu R et al (2007) Congenital heart disease in the general population: changing prevalence and age distribution. Circulation 115:163–172

    Article  PubMed  Google Scholar 

  2. Tweddell JS, Pelech AN, Frommelt PC et al (2000) Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation 102:III130–III135

    Article  PubMed  CAS  Google Scholar 

  3. Powell AJ, Lock JE, Keane JF et al (1995) Prolongation of RV-PA conduit life span by percutaneous stent implantation. Intermediate-term results. Circulation 92:3282–3288

    Article  PubMed  CAS  Google Scholar 

  4. Oosterhof T, Meijboom FJ, Vliegen HW et al (2006) Long-term follow-up of homograft function after pulmonary valve replacement in patients with tetralogy of Fallot. Eur Heart J 27:1478–1484

    Article  PubMed  Google Scholar 

  5. Gatzoulis MA, Balaji S, Webber SA et al (2000) Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 356:975–981

    Article  PubMed  CAS  Google Scholar 

  6. Bonhoeffer P, Boudjemline Y, Saliba Z et al (2000) Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction. Lancet 356:1403–1405

    Article  PubMed  CAS  Google Scholar 

  7. Lurz P, Coats L, Khambadkone S et al (2008) Percutaneous pulmonary valve implantation—impact of evolving technology and learning curve on clinical outcome. Circulation 117:1964–1972

    Article  PubMed  Google Scholar 

  8. Cheatham JP (2001) Stenting of coarctation of the aorta. Catheter Cardiovasc Interv 54:112–125

    Article  PubMed  CAS  Google Scholar 

  9. Coats L, Tsang V, Khambadkone S et al (2005) The potential impact of percutaneous pulmonary valve stent implantation on right ventricular outflow tract re-intervention. Eur J Cardiothorac Surg 27:536–543

    Article  PubMed  Google Scholar 

  10. Coats L, Khambadkone S, Derrick G et al (2006) Physiological and clinical consequences of relief of right ventricular outflow tract obstruction late after repair of congenital heart defects. Circulation 113:2037–2044

    Article  PubMed  Google Scholar 

  11. McElhinney DB, Hellenbrand WE, Zahn EM et al (2010) Short- and medium-term outcomes after transcatheter pulmonary valve placement in the expanded multicenter US Melody valve trial. Circulation 122:507–516

    Article  PubMed  Google Scholar 

  12. Nordmeyer J, Khambadkone S, Coats L et al (2007) Risk stratification, systematic classification, and anticipatory management strategies for stent fracture after percutaneous pulmonary valve implantation. Circulation 115:1392–1397

    Article  PubMed  Google Scholar 

  13. Nordmeyer J, Coats L, Lurz P et al (2008) Percutaneous pulmonary valve-in-valve implantation: a successful treatment concept for early device failure. Eur Heart J 29:810–815

    Article  PubMed  Google Scholar 

  14. Schievano S, Coats L, Migliavacca F et al (2007) Variations in right ventricular outflow tract morphology following repair of congenital heart disease—implications for percutaneous pulmonary valve implantation. J Cardiovasc Magn Reson 9:687–695

    Article  PubMed  Google Scholar 

  15. Schievano S, Petrini L, Migliavacca F et al (2007) Finite element analysis of stent deployment: understanding stent fracture in percutaneous pulmonary valve implantation. J Interv Cardiol 20:546–554

    Article  PubMed  Google Scholar 

  16. Schievano S, Taylor AM, Capelli C et al (2009) Patient specific finite element analysis results in more accurate prediction of stent fractures: application to percutaneous pulmonary valve implantation. J Biomech 43:687–693

    Article  PubMed  Google Scholar 

  17. Schievano S, Migliavacca F, Coats L et al (2007) Percutaneous pulmonary valve implantation based on rapid prototyping of right ventricular outflow tract and pulmonary trunk from MR data. Radiology 242:490–497

    Article  PubMed  Google Scholar 

  18. Marrey RV, Burgermeister R, Grishaber RB et al (2006) Fatigue and life prediction for cobalt-chromium stents: a fracture mechanics analysis. Biomaterials 27:1988–2000

    Article  PubMed  CAS  Google Scholar 

  19. Beden SM, Abdullah S, Ariffin AK et al (2009) Fatigue life assessment of different steel-based shell materials under variable amplitude loading. Eur J Sci Res 29:157–169

    Google Scholar 

  20. Nordmeyer J, Lurz P, Khambadkone S et al (2011) Pre-stenting with a bare metal stent before percutaneous pulmonary valve implantation: acute and 1-year outcomes. Heart 97:118–123

    Article  PubMed  Google Scholar 

  21. Bonhoeffer P, Huynh R, House M et al (2008) Transcatheter pulmonic valve replacement in sheep using a grafted self expanding stent with tissue valve. Circulation 118:S812

    Google Scholar 

  22. Schievano S, Taylor AM, Capelli C et al (2010) First-in-man implantation of a novel percutaneous valve: a new approach to medical device development. EuroIntervention 5:745–750

    Article  PubMed  Google Scholar 

  23. Schievano S, Capelli C, Young C et al (2011) Four-dimensional computed tomography: a method of assessing right ventricular outflow tract and pulmonary artery deformations throughout the cardiac cycle. Eur Radiol 21:36–45

    Article  PubMed  Google Scholar 

  24. Capelli C, Taylor AM, Migliavacca F et al (2010) Patient-specific reconstructed anatomies and computer simulations are fundamental for selecting medical device treatment: application to a new percutaneous pulmonary valve. Philos Transact A Math Phys Eng Sci 368:3027–3038

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Sciences & Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK

    Silvia Schievano PhD, Andrew M. Taylor MD & Philipp Bonhoeffer MD

Authors
  1. Silvia Schievano PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew M. Taylor MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philipp Bonhoeffer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philipp Bonhoeffer MD .

Editor information

Editors and Affiliations

  1. , Mail Code 195, University of Minnesota, Delaware St. SE., 420, MINNEAPOLIS, 55455, Minnesota, USA

    Paul A. Iaizzo

  2. University of Minnesota, DELAWARE ST SE MMC 195 420, MINNEAPOLIS, 55455, Minnesota, USA

    Richard W. Bianco

  3. University of Minnesota, Department of Surgery, Medtronic, Inc., N/A, Minneapolis, 55432, Minnesota, USA

    Alexander J. Hill

  4. University of Minnesota, N/A, Minneapolis, 55455, Minnesota, USA

    James D. St. Louis

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Schievano, S., Taylor, A.M., Bonhoeffer, P. (2013). Percutaneous Pulmonary Valve Implantation: The First Transcatheter Valve. In: Iaizzo, P., Bianco, R., Hill, A., St. Louis, J. (eds) Heart Valves. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-6144-9_9

Download citation

Publish with us

Policies and ethics

Search

Navigation