SAPIEN S3 valve deployment in the pulmonary position using the gore DrySeal sheath to protect the tricuspid valve.
BACKGROUND
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.


METHODS
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.


RESULTS
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 We then performed additional crimping of the S3 onto the balloon after the balloon catheter was withdrawn to position the valve on the balloon outside the body.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.


CONCLUSION
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.
['Stapleton|Gary E|GE|0000-0001-8466-1401', 'Gowda|Srinath T|ST|', 'Bansal|Manish|M|', 'Khan|Asra|A|0000-0001-9653-0388', 'Qureshi|Athar M|AM|0000-0001-5992-568X', 'Justino|Henri|H|']
D000293:Adolescent D000328:Adult D063126:Balloon Valvuloplasty D006328:Cardiac Catheterization D002648:Child D005260:Female D006335:Heart Injuries D006350:Heart Valve Prosthesis D019918:Heart Valve Prosthesis Implantation D006439:Hemodynamics D006801:Humans D008297:Male D011474:Prosthesis Design D011664:Pulmonary Valve D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome D014261:Tricuspid Valve D014262:Tricuspid Valve Insufficiency D055815:Young Adult
SAPIEN tricuspid valve transcatheter pulmonary valve