Use of a novel valve stent for transcatheter pulmonary valve replacement: An animal study Gang-Jun Zong, MD, PhD, Yuan Bai, MD, Hai-Bin Jiang, MD, Wei-Ping.

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Use of a novel valve stent for transcatheter pulmonary valve replacement: An animal study Gang-Jun Zong, MD, PhD, Yuan Bai, MD, Hai-Bin Jiang, MD, Wei-Ping Li, MD, PhD, Hong Wu, MD, PhD, Xian-Xian Zhao, MD, PhD, Yong-Wen Qin, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 137, Issue 6, Pages 1363-1369 (June 2009) DOI: 10.1016/j.jtcvs.2008.12.025 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Pulmonary valve stent construction. A, The valve ring was made of supermalleable nitinol wire bent into 3 arc shapes. B, Three valve leaflets were constructed by trimming porcine pericardium. The valve leaflets were sutured onto the valve ring. One side was denoted the attachment region and the other, margo libra. C, The conduit-shaped stent comprised of the head, neck, and body. The head portion was proximal to the heart end, slightly protruded, and trumpet shaped. The neck portion was thinner and connected the head portion with the body portion. The body portion was a straight tubular shape. The artificial valve was placed within the tubular stent. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1363-1369DOI: (10.1016/j.jtcvs.2008.12.025) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Placement of valved stent into sheath. A, The valved stent was crimped by hand to load into a 14-French sheath. B, The valved stent completely crimped into the sheath. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1363-1369DOI: (10.1016/j.jtcvs.2008.12.025) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Valve stent implantation process (representative images). A, Imaging of the pulmonary valve was performed to measure the pulmonary valve radius and location. B, Steel guide wires were deployed into the left or right pulmonary artery regions to facilitate delivery. C, A 14-French delivery sheath was inserted into the pulmonary artery. D, The neck portion of the stent was delivered to the previously noted location of the pulmonary valve. E, The delivery sheath was retracted and the stent released. F, Image of the artificial pulmonary valve revealing good placement and no regurgitation. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1363-1369DOI: (10.1016/j.jtcvs.2008.12.025) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Heart function and hemodynamic markers before, immediately after, and 6 months after implantation. Heart rate (A), mean arterial pressure (B), right ventricle pressure (C), pulmonary artery pressure (D), right ventricular volumes (E), right ventricle ejection fraction (F), transvalvular gradients (G), and effective orifice areas (H) were assessed. ∗P < .05 between the indicated means. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1363-1369DOI: (10.1016/j.jtcvs.2008.12.025) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Pulmonary artery valve stent 6 months after implantation: color ultrasonography and computed tomography examination findings from a representative animal. A, Artificial valve opening (white arrow). B, Artificial valve closing (white arrow). C, Color Doppler ultrasonography revealed no patterns of blood passing or regurgitation. D, Right ventricular ejection fraction. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1363-1369DOI: (10.1016/j.jtcvs.2008.12.025) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Six-month postoperative electron microscopy images of a stent. A, Nitinol wire covered by endothelial cells (magnification 100×). B, The stent was completely covered by neatly arranged endothelial cells (magnification 1500×). The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1363-1369DOI: (10.1016/j.jtcvs.2008.12.025) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Color Doppler ultrasonography examinations were performed 2 months after the second valve stent implantation. A, Spectral of the pulmonary valve revealed mild regurgitation. B, Motion mode ultrasonography revealed normal cardiac function. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1363-1369DOI: (10.1016/j.jtcvs.2008.12.025) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions