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Redo prosthetic valve replacement has remained, until now, the sole effective treatment for severely deteriorated bioprosthetic valves, but this procedure carries an increased operative risk in comparison to the first operation 1. With the broadening of the indication of bioprosthetic valve replacement, more and more cases are expected to occur in the future, particularly in elderly patients.

Endovascular valve implantation VI might be a valuable alternative to conventional surgery in this high risk population.

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Endovascular VI has already been performed in patients suffering from aortic stenosis or pulmonary insufficiency using either balloon expandable or self-expandable valved stents A major problem encountered with percutaneous VI is the impossibility to readjust the position of a valved stent VS once fully deployed.

Bad positioning of the VS could lead to a fatal peri-procedural issue 3. None of the available VS has the potential to be repositioned after complete deployment 5. Thus, being able to reposition a fully deployed VS could prove of crucial importance and would certainly favour the development of percutaneous VI by improving the safety of the procedure. We have evaluated an original ancillary system allowing a self-expandable VS to be repositioned as often as necessary during the procedure. The prototype consisted in a semi-rigid delivery catheter made of polyvinyl chloride. Two sutures ran along the internal lumen of the delivery catheter.

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At their distal part, these two sutures encircled the VS, thus allowing its attachment to the tip of the catheter Figure 1. Figure 1. Valved stent attached to the tip of the delivery catheter note the presence of 2 encircling sutures. At their proximal part, the sutures were attached to a handle. Traction or relaxation of the handle was associated to compression or relaxation of the VS video 1. Once deployed in adequate position, the VS was definitely released from the delivery catheter by pulling on a wire that controlled the attachment of the two sutures.

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The delivery catheter could then be withdrawn leaving the VS in place. We developed an animal model of tricuspid bioprosthetic failure in sheep. This consisted in surgical implantation of a pericardial bioprosthesis, the anterior leaflet of which was torn. The procedure took no more than two minutes and was haemodynamically well tolerated.

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The repositioning capacity of the delivery device was confirmed in all experiments with no failure video 2. Bioprosthetic failure was always corrected, with no residual intra- or periprosthetic leak on echocardiography. Figure 2. Apical view of the heart the right atrium and the anterior part of the right ventricle have been resected showing excellent positioning of the stented valve inside the failed bioprosthesis. In order to achieve adequate positioning of the VS, right ventricular pacing or use of extracorporeal circulation during VS delivery has been recommended by others. With the present device, these potentially deleterious strategies are likely to be unnecessary, as it was the case in our experimental study.

This original delivery device permitted the reversibility of the VS positioning as many times as needed prior to the final release.

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This relied on a simple manoeuvre compression-relaxation of the VS that could be performed by one operator only. Optimal therapeutic management of glycemia and other cardiovascular risk factors decreases the risk of DAN and in confirmed cases of DAN such management reduces the risk of complications and mortality. Unable to display preview. Download preview PDF. Skip to main content. Advertisement Hide.

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Authors Authors and affiliations K. Hubeaux X. Deffieux P. Raibaut D. Rogez F. Lebreton A. Marquer G.

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Chandrasekharan B, Srinivasan S Diabetes and the enteric nervous system. Diabetologia 41 4 : — Google Scholar. The consensus Committee of the American Autonomic Society and the American Academy of Neurology Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology Google Scholar. Clinical autonomic disorders, 2nd edition. Hubeaux 1 2 3 Email author X. Deffieux 1 2 3 P.