51
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Kuo JA, Schutte DA. Aortic Root Distortion During Balloon Angioplasty of Right Ventricular Outflow Tract Prior to Transcatheter Pulmonary Valve Implantation. Pediatr Cardiol 2021; 42:302-306. [PMID: 33040259 DOI: 10.1007/s00246-020-02483-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022]
Abstract
We describe our experience with aortic root distortion in transcatheter pulmonary valve implantation (TPVI). Aortic root distortion (AD) can be observed with balloon angioplasty of the right ventricular outflow tract (RVOT), but its long-term significance is unknown. This has been a common finding in our institution, though not fully appreciated in our early experience. Retrospective review of procedural angiograms prior to TPVI and follow up imaging was performed. Between June 2012 and October 2017, 47 patients underwent catheterization to attempt TPVI. Five patients had coronary compression which precluded TPVI (one with significant AD as well). Four patients had significant AD and did not receive TPVI. Of the remaining 38 successful TPVI, 20 had adequate imaging to assess the aortic root. Four patients had severe AD, 7 had mild AD, and 9 with no AD. Severity of AI did not correlate with degree of AD. Median follow up after TPVI was 46 months (IQR 21-67). Of the 4 patients with severe AD who received TPVI, 1 has new mild AI with 78 months follow up. Of the 18 patients who received TPVI without adequate arch imaging, 2 patients have new mild AI with 86 and 75 months follow up. AD during RVOT angioplasty is a relatively common finding. In our early experience, some patients who were retrospectively identified to have severe AD received TPVI. These patients have done well, though further data is needed before considering severe AD a benign finding.
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Affiliation(s)
- James A Kuo
- Division of Pediatric Cardiology, Children's Healthcare of Atlanta/Emory University School of Medicine, 2835 Brandywine Road, Suite 400, Atlanta, 30341, GA, USA.
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52
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Kuang D, Lei Y, Yang L, Wang Y. Preclinical study of a self-expanding pulmonary valve for the treatment of pulmonary valve disease. Regen Biomater 2020; 7:609-618. [PMID: 33365146 PMCID: PMC7748448 DOI: 10.1093/rb/rbaa035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Abstract
In the past decade, balloon-expandable percutaneous pulmonary valves have been developed and applied in clinical practice. However, all the existing products of pulmonary artery interventional valves in the market have a straight structure design, and they require a preset support frame and balloon expansion. This shape design of the valve limits the application range. In addition, the age of the population with pulmonary artery disease is generally low, and the existing products cannot meet the needs of anti-calcification properties and valve material durability. In this study, through optimization of the support frame and leaflet design, a self-expanding pulmonary valve product with a double bell-shaped frame was designed to improve the match of the valve and the implantation site. A loading and deployment study showed that the biomaterial of the valve was not damaged after being compressed. Pulsatile flow and fatigue in vitro tests showed that the fabricated pulmonary valve met the hydrodynamic requirements after 2 × 108 accelerated fatigue cycles. The safety and efficacy of the pulmonary valve product were demonstrated in studies of pulmonary valve implantation in 11 pigs. Angiography and echocardiography showed that the pulmonary valves were implanted in a good position, and they had normal closure and acceptable valvular regurgitation. The 180 days' implantation results showed that the calcium content was 0.31-1.39 mg/g in the anti-calcification treatment group, which was significantly lower than that in the control valve without anti-calcification treatment (16.69 mg/g). Our new interventional pulmonary valve product was ready for clinical trials and product registration.
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Affiliation(s)
- Dajun Kuang
- National Engineering Research Center for Biomaterials, Sichuan University, No 29 Wangjiang Road, Chengdu 610064, China.,Venus Medtech (Hangzhou) Inc., 88 Jiangling Road, Hangzhou 311053, China
| | - Yang Lei
- National Engineering Research Center for Biomaterials, Sichuan University, No 29 Wangjiang Road, Chengdu 610064, China
| | - Li Yang
- National Engineering Research Center for Biomaterials, Sichuan University, No 29 Wangjiang Road, Chengdu 610064, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, No 29 Wangjiang Road, Chengdu 610064, China
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53
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Hermsen JL. Commentary: Kids are not little adults, but there is no reason they cannot be helped with adult tools. JTCVS Tech 2020; 6:125. [PMID: 34318168 PMCID: PMC8300906 DOI: 10.1016/j.xjtc.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Joshua L Hermsen
- Division of Cardiothoracic Surgery, University of Wisconsin-Madison, American Family Children's Hospital, Madison, Wisc
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54
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McElhinney DB. Prevention and management of endocarditis after transcatheter pulmonary valve replacement: current status and future prospects. Expert Rev Med Devices 2020; 18:23-30. [PMID: 33246368 DOI: 10.1080/17434440.2021.1857728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Transcatheter pulmonary valve replacement (TPVR) has become an important tool in the management of congenital heart disease with abnormalities of the right ventricular outflow tract. Endocarditis is one of the most serious adverse long-term outcomes and among the leading causes of death in patients with congenital heart disease and after (TPVR).Areas covered: This review discusses the current state knowledge about the risk factors for and outcomes of endocarditis after transcatheter pulmonary valve replacement in patients with congenital and acquired heart disease. It also addresses practical measures for mitigating endocarditis risk, as well as diagnosing and managing endocarditis when it does occur.Expert opinion: With increasing understanding of the risk factors for and management and outcomes of endocarditis in patients who have undergone TPVR, we continue to learn how to utilize TPVR most effectively in this complex population of patients.
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Affiliation(s)
- Doff B McElhinney
- Departments of Cardiothoracic Surgery and Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA, USA
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55
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Postalian A, Krajcer Z. Preventing tricuspid valve injury during transcatheter pulmonary valve replacement. Catheter Cardiovasc Interv 2020; 96:1294-1295. [PMID: 33217181 DOI: 10.1002/ccd.29362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/09/2022]
Abstract
The transcatheter pulmonary valve replacement technique has evolved over the past decade. There is risk of injuring the tricuspid valve if the transcatheter device is advanced uncovered across the right heart. Advancing a long sheath past the landing zone and uncovering the device can help mitigate this risk, at the expense of requiring larger-caliber sheaths. Additional refinements of the technique such as the one reported here, along with improvements in device design, are likely to further reduce complications.
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Affiliation(s)
- Alexander Postalian
- Department of Cardiology, Texas Heart Institute, Houston, Texas, USA.,Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Houston, Texas, USA.,Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
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56
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Meca Aguirrezabalaga JA, Silva Guisasola J, Díaz Méndez R, Escalera Veizaga AE, Hernández-Vaquero Panizo D. Pulmonary regurgitation after repaired tetralogy of Fallot: surgical versus percutaneous treatment. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:967. [PMID: 32953767 PMCID: PMC7475380 DOI: 10.21037/atm.2020.03.81] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pulmonary regurgitation is the most important sequellae after correction of Tetralogy of Fallot and has a considerable impact over the right ventricle. Surgery has demonstrated low early mortality after pulmonary valve replacement and good long-term outcomes, remaining nowadays the gold standard treatment of pulmonary regurgitation in rTOF patients. Nevertheless, transcatheter pulmonary valve implantation has emerged as a new, safe and efficient alternative to surgical valve replacement. In this review article, we try to evaluate and compare both techniques to find out which is the best therapeutic option in this patients.
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Affiliation(s)
| | - Jacobo Silva Guisasola
- Department of Cardiac Surgery, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rocío Díaz Méndez
- Department of Cardiac Surgery, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
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Utility of Three-Dimensional (3D) Modeling for Planning Structural Heart Interventions (with an Emphasis on Valvular Heart Disease). Curr Cardiol Rep 2020; 22:125. [PMID: 32789652 DOI: 10.1007/s11886-020-01354-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Advanced imaging has played a vital role in the contemporary, rapid rise of structural heart interventions. 3D modeling and printing has emerged as one of the most recent imaging tools and the implementation of 3D modeling is expected to increase with further advances in imaging, print hardware, and materials. RECENT FINDINGS 3D modeling can be used to educate patients and clinical teams, provide ex vivo procedural simulation, and improve outcomes. Intra-procedural success rates may be improved, and post-procedural complications can be predicted more robustly with appropriate application of 3D modeling. Recent advances in technology have increased the availability of this tool, such that there can be more ready adoption into a routine clinical workflow. Familiarity with 3D modeling and its current utilization and role in structural interventions will help inform how to approach and adapt this exciting new technology.
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58
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Abstract
This article provides a detailed review of the current practices and future directions of transcatheter interventions in adults with congenital heart disease. This includes indications for intervention, risks, and potential complications, as well as a review of available devices and their performance.
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59
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Faccini A, Giugno L, Piazza L, d'Aiello AF, Pluchinotta FR, Chessa M, Carminati M. Evolving Technique for SAPIEN Pulmonary Valve Implantation: A Single-Center Experience. JACC Cardiovasc Interv 2020; 13:1500-1502. [PMID: 32553343 DOI: 10.1016/j.jcin.2020.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/06/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
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60
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Alkashkari W, Albugami S, Abbadi M, Niyazi A, Alsubei A, Hijazi ZM. Transcatheter pulmonary valve replacement in pediatric patients. Expert Rev Med Devices 2020; 17:541-554. [PMID: 32459512 DOI: 10.1080/17434440.2020.1775578] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Right ventricular outflow tract (RVOT) dysfunction is common among individuals with congenital heart disease (CHD). Surgical intervention often carries prohibitive risks due to the need for sequential pulmonary valve (PV) replacements throughout their life in the majority of cases. Transcatheter pulmonary valve replacement (tPVR) is one of the most exciting recent developments in the treatment of CHD and has evolved to become an attractive alternative to surgery in patients with RVOT dysfunction. AREAS COVERED In this review, we examine the pathophysiology of RVOT dysfunction, indications for tPVR, and the procedural aspect. Advancements in clinical application and valve technology will also be covered. EXPERT OPINION tPVR is widely accepted as an alternative to surgery to address RVOT dysfunction, but still significant numbers of patients with complex RVOT morphology deemed not suitable for tPVR. As the technology continues to evolve, new percutaneous valves will allow such complex RVOT patient to benefit from tPVR.
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Affiliation(s)
- Wail Alkashkari
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Saad Albugami
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Mosa Abbadi
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Akram Niyazi
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Amani Alsubei
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Ziyadi M Hijazi
- Sidra Heart Center, Sidra Medicine , Doha, Qatar.,Medical Research Department, Weill Cornell Medicine , New York, NY, USA
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61
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Recent clinical trials in valvular heart diseases. Curr Opin Cardiol 2020; 35:313-318. [DOI: 10.1097/hco.0000000000000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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62
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Crethers D, Kalish J, Shafer B, Mathis L, Polimenakos AC. Right Ventricular Outflow Tract Reintervention in the Transcatheter Era: Outcomes and Cost Analysis. Pediatr Cardiol 2020; 41:599-606. [PMID: 31894397 DOI: 10.1007/s00246-019-02281-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/17/2019] [Indexed: 11/26/2022]
Abstract
Surgical pulmonary valve insertion (SPVI) for re-entry right ventricular outflow tract intervention (RVOTI) remains an established and reproducible approach. Fast-track in patients undergoing RVOTI of the comprehensive valve program targets early ICU and hospital discharge (Hd). Feasibility study for outcome and cost analysis was undertaken. Between January 2015 and December 2016, 34 patients underwent re-entry RVOTI. Seventeen had SPVI and 17 transcatheter PVI (TPVI). Surgical perioperative fast-track protocol was used. Echocardiographic evaluation preoperatively (TTE-1), after RVOTI (TTE-2), at hospital discharge (TTE-3), and follow-up (TTE-4) were obtained. Cost Analysis included procedural and hospital costs. Mean follow-up period was 11.3 ± 6.9 months. All patients were extubated prior to ICU arrival. Mean age was 8.5 ± 7.8 for SPVI [vs 28.5 ± 8.6 years for TPVI] (p < 0.05). There was no hospital mortality or 30-day readmission for SPVI (versus 1 for TPVI).Mean hospital length of stay (LOS) was 4.1 ± 1.1 days for SPVI [vs 1.1 ± 0.7 days for TPVI] (p < 0.05). Number of prior sternal re-entry had no influence on outcome. RV systolic pressure referenced to LVSP (rRVSP, %) and diastolic dimension (RVEDDi, z score) showed sustainable improvement (TTE-2, TTE-3, TTE-4) in both groups compared to TTE-1 (p < 0.05). Mean total hospital cost was $5475.86 ± 2503.91 lower after SPVI (p = 0.09), 21.7% procedural cost reduction. Patients undergoing RVOTI can be safely stratified, based on a customized concept, towards SPVI or TPVI. Standardized strategy can advocate a fast-track path. SPVI is associated with comparable mid-term outcomes to TPVI although SPVI is delivered in younger patients. Despite longer LOS SPVI is associated with reduced hospital cost. Multisite studies might help determine suitability for each strategy on cost containment/quality of life basis.
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Affiliation(s)
- Danielle Crethers
- Division of Congenital and Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia Medical College of Georgia, Augusta, GA, USA
| | - Joshua Kalish
- Department of Educational Affairs, Medical College of Georgia, Augusta, GA, USA
| | - Brendan Shafer
- Division of Congenital and Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia Medical College of Georgia, Augusta, GA, USA
| | - Lauren Mathis
- Division of Congenital and Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia Medical College of Georgia, Augusta, GA, USA
| | - Anastasios C Polimenakos
- Division of Congenital and Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia Medical College of Georgia, Augusta, GA, USA.
- Medical College of Georgia Congenital and Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia, 1120 15th Street BAA 8222, Augusta, GA, 30912, USA.
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63
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Goldstein BH, Bergersen L, Armstrong AK, Boe BA, El-Said H, Porras D, Shahanavaz S, Leahy RA, Kreutzer J, Zampi JD, Hainstock MR, Gudausky TM, Nicholson GT, Gauvreau K, Goodman A, Petit CJ. Adverse Events, Radiation Exposure, and Reinterventions Following Transcatheter Pulmonary Valve Replacement. J Am Coll Cardiol 2020; 75:363-376. [DOI: 10.1016/j.jacc.2019.11.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/26/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022]
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64
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Aggarwal V, Spigel ZA, Hiremath G, Binsalamah Z, Qureshi AM. Current clinical management of dysfunctional bioprosthetic pulmonary valves. Expert Rev Cardiovasc Ther 2020; 18:7-16. [DOI: 10.1080/14779072.2020.1715796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA
| | - Zachary A Spigel
- Department of Pediatric Surgery, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Gurumurthy Hiremath
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA
| | - Ziyad Binsalamah
- Department of Pediatric Surgery, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
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65
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Godoy M, Mugharbil A, Anastasius M, Leipsic J. Cardiac Computed Tomography (CT) Evaluation of Valvular Heart Disease in Transcatheter Interventions. Curr Cardiol Rep 2019; 21:154. [DOI: 10.1007/s11886-019-1241-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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66
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Driesen BW, Warmerdam EG, Sieswerda GJ, Meijboom FJ, Molenschot MMC, Doevendans PA, Krings GJ, van Dijk APJ, Voskuil M. Percutaneous Pulmonary Valve Implantation: Current Status and Future Perspectives. Curr Cardiol Rev 2019; 15:262-273. [PMID: 30582483 PMCID: PMC8142351 DOI: 10.2174/1573403x15666181224113855] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 02/07/2023] Open
Abstract
Patients with congenital heart disease (CHD) with right ventricle outflow tract (RVOT) dysfunction need sequential pulmonary valve replacements throughout their life in the majority of cases. Since their introduction in 2000, the number of percutaneous pulmonary valve implantations (PPVI) has grown and reached over 10,000 procedures worldwide. Overall, PPVI has been proven safe and effective, but some anatomical variations can limit procedural success. This review discusses the current status and future perspectives of the procedure.
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Affiliation(s)
- Bart W Driesen
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Cardiology, Radboudumc, Nijmegen, Netherlands
| | | | - Gert-Jan Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Folkert J Meijboom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands.,Central Military Hospital, Utre cht, Netherlands
| | - Gregor J Krings
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
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67
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Park J, Suradi HS. State-of-the-art Structural Interventions in Heart Failure. Card Fail Rev 2019; 5:147-154. [PMID: 31768271 PMCID: PMC6848934 DOI: 10.15420/cfr.2019.12.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/05/2019] [Indexed: 11/04/2022] Open
Abstract
Heart failure (HF) is a leading cause of hospitalisation and healthcare costs worldwide. Acute decompensated heart failure accounts for more than 1 million hospitalisations in the US. Despite advances in the quality of acute and chronic HF disease management, gaps in knowledge about effective interventions to support the transition of care for patients with HF remain. Despite multiple trials of promising therapies, standard care consists of decongestion with IV diuretics and haemodynamic support with vasodilators and inotropes and this has remained largely unchanged during the past 45 years. Newer advances in medical innovations and structural heart disease interventions have now given promise to improved survival, outcomes and quality of life for patients with advanced HF of multiple aetiologies. In this article, we focus on structural interventions in the treatment of patients with HF.
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Affiliation(s)
- Jeffrey Park
- Department of Internal Medicine, Division of Cardiovascular Medicine, Rush University Medical Center Chicago, IL, US
| | - Hussam S Suradi
- Department of Internal Medicine, Division of Cardiovascular Medicine, Rush University Medical Center Chicago, IL, US
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68
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The risk of infective endocarditis following interventional pulmonary valve implantation: A meta-analysis. J Cardiol 2019; 74:197-205. [DOI: 10.1016/j.jjcc.2019.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/22/2019] [Accepted: 04/13/2019] [Indexed: 11/19/2022]
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69
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Lehner A, Dashkalova T, Ulrich S, Fernandez Rodriguez S, Mandilaras G, Jakob A, Dalla-Pozza R, Fischer M, Schneider H, Tarusinov G, Kampmann C, Hofbeck M, Dähnert I, Kanaan M, Haas NA. Intermediate outcomes of transcatheter pulmonary valve replacement with the Edwards Sapien 3 valve - German experience. Expert Rev Med Devices 2019; 16:829-834. [PMID: 31432698 DOI: 10.1080/17434440.2019.1653180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: After encouraging results with the Edwards Sapien and XT valves, this study aimed to review procedural data and early outcomes for the Sapien 3 valves for transcatheter pulmonary valve replacement (TPVR). Methods: We performed a multicenter, retrospective analysis of cases who underwent a Sapien 3 TPVR between 2015 and 2017 in 7 centers in Germany with a follow-up of up to 2 years. Results: 56 patients could be enrolled (weight 58,5 ± 25,0 kg; 53% Tetralogy of Fallot, 45% native RVOT). Most procedures were two-stage procedures (82,1%) with 100% prestenting. Valve sizes were 20 mm (n = 1), 23 mm (n = 15), 26 mm (n = 27), 29 mm (n = 13). Procedural success rate was 96.4%. Two patients underwent surgical valve implantation after balloon rupture during TPVR. Follow-up data were available up to 24-month post TPVR. The rate of patients with ? moderate and severe pulmonary regurgitation decreased to 0% after TPVR, peak systolic gradient decreased from 24,2 (SD±20,9) mmHg to 7,1 mmHg (SD±5,0). There were no endocarditis, severe tricuspid valve impairment or stent fractures. Conclusions: With the Edwards Sapien 3 valve, the patient pool for TPVR can be substantially extended. Continued data collection is necessary to verify long-term results.
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Affiliation(s)
- Anja Lehner
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Tsvetina Dashkalova
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Sarah Ulrich
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Silvia Fernandez Rodriguez
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Guido Mandilaras
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Andre Jakob
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Robert Dalla-Pozza
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Marcus Fischer
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Heike Schneider
- Department for Pediatric Cardiology and Intensive Care, Heart Center Goettingen, Georg-August-University Goettingen , Goettingen , Germany
| | - Gleb Tarusinov
- Department for Pediatric Cardiology, Heart Center Duisburg , Duisburg , Germany
| | - Christoph Kampmann
- Department for Pediatric Cardiology, University Medical Center Mainz , Mainz , Germany
| | - Michael Hofbeck
- Department for Pediatric Cardiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Ingo Dähnert
- Department for Pediatric Cardiology, Heart Center Leipzig , Leipzig , Germany
| | - Majed Kanaan
- Center for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum , Bad Oeynhausen , Germany
| | - Nikolaus A Haas
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
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Balzer D. Pulmonary Valve Replacement for Tetralogy of Fallot. Methodist Debakey Cardiovasc J 2019; 15:122-132. [PMID: 31384375 DOI: 10.14797/mdcj-15-2-122] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Right ventricular outflow tract (RVOT) dysfunction is common following surgical repair of tetralogy of Fallot and other forms of complex congenital heart disease. This results in pulmonary stenosis or regurgitation and may ultimately lead to RV failure and dysrhythmias. Transcatheter valve technologies are now available to treat certain patients with RVOT dysfunction. Current devices include the Medtronic Melody valve and the Edwards Lifesciences SAPIEN XT. Although these valves are approved for use in dysfunctional circumferential RVOT conduits, they are increasingly being used off label for nonconduit outflow tracts. Procedural complications include but are not limited to conduit rupture and coronary compression. Longer-term complications include stent fracture and endocarditis. Outcomes with these valves have demonstrated durable relief of stenosis and regurgitation. The Medtronic Harmony valve and the Alterra Prestent from Edwards Lifesciences are investigational devices that are intended to treat the patulous RVOT that is too large to accommodate currently available valves. This review will focus on current indications to treat RVOT dysfunction, existing transcatheter valve technologies, and investigational devices undergoing clinical trials. Hopefully, within the not-too-distant future, transcatheter pulmonary valve implantation will be feasible in the vast majority of patients with RVOT dysfunction following surgical repair of congenital heart disease.
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Affiliation(s)
- David Balzer
- ST. LOUIS CHILDREN'S HOSPITAL, ST. LOUIS, MISSOURI
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Kenny D, Morgan GJ, Murphy M, AlAlwi K, Giugno L, Zablah J, Carminati M, Walsh K. Use of 65 cm large caliber Dryseal sheaths to facilitate delivery of the Edwards SAPIEN valve to dysfunctional right ventricular outflow tracts. Catheter Cardiovasc Interv 2019; 94:409-413. [PMID: 31408262 DOI: 10.1002/ccd.28409] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/10/2019] [Accepted: 07/10/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Edwards SAPIEN valve and its delivery system may complicate transit through the right heart during transcatheter pulmonary valve replacement (tPVR). We report our early experience using a large diameter, 65 cm delivery sheath to facilitate delivery of the SAPIEN valve to the right ventricular outflow tract (RVOT). METHODS Retrospective analysis of all patients from three large congenital heart centers undergoing tPVR with the Edwards SAPIEN valve delivered with the 65 cm Gore Dryseal Sheath. RESULTS Over a 12 month period, 30 patients (17 female) with median age 17.5 years (range 8-72) underwent attempted tPVR with the SAPIEN valve delivered using the 65 cm Dryseal sheath (20-26Fr). All procedures resulted in successful valve delivery to the target area. Twenty patients had a native RVOT. The most commonly used valve diameter was 29 mm (n = 15) with the majority of cases requiring a 26Fr Dryseal sheath (n = 20). One patient with severe RVOT stenosis underwent prestenting. Median procedure time was 100 min (59-225). No patient had increase in tricuspid valve regurgitation as a consequence of valve delivery. One patient required a synchronous cardioversion for intraprocedural VT and another required ECMO postprocedure due to severe pre-existing left ventricular dysfunction. On median follow-up of 5 months, all patients had mild or less pulmonary regurgitation. Median peak Doppler velocity across the pulmonary valve was 2.2 m/s (1.7-4). There were no clinically relevant complications relating to vascular access. CONCLUSIONS Using 65 cm Dryseal sheaths facilitates delivery of SAPIEN valves in patients with dysfunctional RVOTs.
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Affiliation(s)
- Damien Kenny
- Department of Paediatric Cardiology and Cardiac Surgery, Our Lady's Children's Hospital, Dublin, Ireland
- National Adult Congenital Heart Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gareth J Morgan
- The Heart Institute, Children's Hospital of Colorado, Denver, CO
- Department of Adult Congenital Cardiology, University of Colorado Hospital, Denver, CO
| | - Matthew Murphy
- National Adult Congenital Heart Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Khalid AlAlwi
- Department of Paediatric Cardiology and Cardiac Surgery, Our Lady's Children's Hospital, Dublin, Ireland
| | - Luca Giugno
- Department of Pediatric Cardiology & Adult Congenital Heart Disease, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
| | - Jenny Zablah
- The Heart Institute, Children's Hospital of Colorado, Denver, CO
| | - Mario Carminati
- Department of Pediatric Cardiology & Adult Congenital Heart Disease, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
| | - Kevin Walsh
- Department of Paediatric Cardiology and Cardiac Surgery, Our Lady's Children's Hospital, Dublin, Ireland
- National Adult Congenital Heart Service, Mater Misericordiae University Hospital, Dublin, Ireland
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Eicken A, Ewert P. Is It Wise to Implant a SAPIEN Transcatheter Heart Valve in a Dysfunctional Right Ventricular Outflow Tract? JACC Cardiovasc Interv 2018; 11:1930-1931. [DOI: 10.1016/j.jcin.2018.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 11/29/2022]
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