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Mise au point d’une prothèse valvulaire implantée par voie endovasculaire : effet du sertissage et déploiement sur les feuillets valvulaires et application aux voies pulmonaires dilatées

Abstract : Percutaneous valve implantation (PVI) is a new with fast growing expansion procedure. Nevertheless, this promising technic has some reefs. Impairment of the implanted device at deployment is one of them. Valvular implantation in dilated right ventricular outflow tract (RVOT) is another limit of the procedure. In our work, we studied the valvular traumatism after prosthesis deployment. Subsequently, we evaluated a new device for RVOT size reduction, in order to widen PVI indications.Firstly, We compared 2 types of valved-stent (VS) (balloon expandable and self-expandable). We compared the occurrence of valvular leaflets injury after crimping and deployment of both types of prosthesis. We showed the occurrence of pericardial leaflet injuries, induced by devices crimping. Otherwise, the presence of sharp histologic lesions with balloon expandable VS, suggests a prosthesis expansion role, in genesis of valvular injuries, as well. We couldn’t show any impairment of valvular tissue mechanical properties after leaflets crimping and deployment. In another part of our work, experimental asymmetric enlargement of the RVOT with creation of severe pulmonary regurgitation, were performed in an ovine model. Size reduction of the enlarged RVOT and PVI were successfully achieved through an endovascular and right transventricular access. Valve function was satisfactory in all correctly implanted VS (one case of inversion). No migration or fractures of the size reducer or VS were seen before animal sacrifice, after 2 months follow-up. Since feasibility of RVOT enlargement and RVOT reduction has been demonstrated, a long-term study is necessary before considering a human implantation. At last but not least, deterioration on valvular leaflets after prosthesis handling is an effect to consider. Taking into account its potential impact on prosthesis durability, it requires further deep investigations.
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Brahim Amahzoune. Mise au point d’une prothèse valvulaire implantée par voie endovasculaire : effet du sertissage et déploiement sur les feuillets valvulaires et application aux voies pulmonaires dilatées. Médecine humaine et pathologie. Université Paris Sud - Paris XI, 2012. Français. ⟨NNT : 2012PA114864⟩. ⟨tel-00767945⟩

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