101
|
Boe BA, Cheatham SL, Armstrong AK, Berman DP, Chisolm JL, Cheatham JP. Leaflet morphology classification of the Melody Transcatheter Pulmonary Valve. CONGENIT HEART DIS 2018; 14:297-304. [PMID: 30548926 DOI: 10.1111/chd.12728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/13/2018] [Accepted: 11/22/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to describe the leaflet morphology variation in the Melody Transcatheter Pulmonary Valve (TPV) and evaluate associated outcomes. The Melody TPV is constructed from harvested bovine jugular venous valves which have been rigorously tested. Natural anatomic leaflet variations are seen in the Melody TPV but have not been evaluated. DESIGN A Melody TPV leaflet morphology classification system was devised after reviewing a subset of photographed and implanted TPVs. All images were blindly reviewed by implanters and classified. Midterm hemodynamic outcomes and complications of the Melody TPVs were compared by leaflet morphology. RESULTS Photographed Melody TPVs implanted between 2011 and 2016 (n = 62) were categorized into the following leaflet morphology types: A-symmetric trileaflet (47%); B-asymmetric trileaflet with a single small leaflet (32%); C-asymmetric trileaflet with a single large leaflet (16%); D-rudimentary leaflet with near bicuspid appearance (5%). Acceptable hemodynamic function at 6 months postimplantation was seen in 97.5% of valves. Over a median follow-up of 1.5 years (range 0-4.4 years), two TPVs (Type A) had > mild regurgitation. Nine TPVs developed complications (endocarditis, 3; stent fracture, 2; refractory arrhythmia, 1; conduit replacement, 2; death, 1), of which 6 required reintervention. There was no significant difference in outcomes based on Melody TPV leaflet morphology type. CONCLUSIONS The Melody TPV can be classified into one of four categories based on leaflet morphology. Study outcomes were not associated with leaflet morphology. Further documentation and evaluation of Melody TPV morphology may lead to better understanding of this technology.
Collapse
Affiliation(s)
- Brian A Boe
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | | | | | - Darren P Berman
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Joanne L Chisolm
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - John P Cheatham
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|
102
|
Sinha S, Aboulhosn J, Asnes J, Bocks M, Zahn E, Goldstein BH, Zampi J, Hellenbrand W, Salem M, Levi D. Initial results from the off‐label use of the SAPIEN S3 valve for percutaneous transcatheter pulmonary valve replacement: A multi‐institutional experience. Catheter Cardiovasc Interv 2018; 93:455-463. [DOI: 10.1002/ccd.27973] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/15/2018] [Accepted: 10/19/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Sanjay Sinha
- Department of Pediatrics, Division of CardiologyUCLA Mattel Children's Hospital Los Angeles California
| | - Jamil Aboulhosn
- Department of Pediatrics, Division of CardiologyUCLA Mattel Children's Hospital Los Angeles California
- Department of MedicineAhmanson Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA Los Angeles California
| | - Jeremy Asnes
- Department of Pediatrics, Division of Cardiology, Yale Medical Center New Haven Connecticut
| | - Martin Bocks
- Department of Pediatrics, Division of Pediatric CardiologyUH Rainbow Babies and Children's Hospital Cleveland Ohio
| | - Evan Zahn
- Guerin Family Congenital Heart ProgramThe Heart Institute and Department of Pediatrics Cedars‐Sinai Medical Center Los Angeles California
| | - Bryan H. Goldstein
- Department of Pediatrics, Division of CardiologyCincinnati Children's Hospital Cincinnati Ohio
| | - Jeffrey Zampi
- Department of Pediatrics, Division of CardiologyUniversity of Michigan Ann Arbor Michigan
| | - William Hellenbrand
- Department of Pediatrics, Division of Cardiology, Yale Medical Center New Haven Connecticut
| | - Morris Salem
- Department of Pediatrics, Division of CardiologyKaiser Permanente Los Angeles California
| | - Daniel Levi
- Department of Pediatrics, Division of CardiologyUCLA Mattel Children's Hospital Los Angeles California
- Department of MedicineAhmanson Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA Los Angeles California
| |
Collapse
|
103
|
Tay LWE, Yip WLJ, Low TT, Yip CLW, Kong KFW, Yeo TC, Tan HC, Quereshi SA, Quek SC. Percutaneous pulmonary valve implantation as an alternative to repeat open-heart surgery for patients with pulmonary outflow obstruction: a reality in Singapore. Singapore Med J 2018; 60:260-264. [PMID: 30488081 DOI: 10.11622/smedj.2018141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Right ventricle to pulmonary artery (RV-PA) conduits have been used for the surgical repair of congenital heart defects. These conduits frequently become stenosed or develop insufficiency with time, necessitating reoperations. Percutanous pulmonary valve implantation (PPVI) can delay the need for repeated surgeries in patients with congenital heart defects and degenerated RV-PA conduits. We presented our first experience with PPVI and described in detail the procedural methods and the considerations that are needed for this intervention to be successful. Immediate and short-term clinical outcomes of our patients were reported. Good haemodynamic results were obtained, both angiographically and on echocardiography. PPVI provides an excellent alternative to repeat open-heart surgery for patients with congenital heart defects and degenerated RV-PA conduits. This represents a paradigm shift in the management of congenital heart disease, which is traditionally managed by open-heart surgery.
Collapse
Affiliation(s)
- Lik Wui Edgar Tay
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Wei Luen James Yip
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ting Ting Low
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Chin Ling William Yip
- Department of Pediatrics, National University of Singapore, Singapore.,Department of Paediatric Cardiology, Gleneagles Hospital, Singapore
| | | | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | | | - Swee Chye Quek
- Department of Pediatrics, National University of Singapore, Singapore
| |
Collapse
|
104
|
Zahn EM. Self-Expanding Pulmonary Valves for Large Diameter Right Ventricular Outflow Tracts. Interv Cardiol Clin 2018; 8:73-80. [PMID: 30449423 DOI: 10.1016/j.iccl.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Congenital heart defects that involve obstruction to the right ventricular outflow tract are common. Surgical repair involves early relief of right ventricular outflow tract obstruction, which typically results in pulmonary regurgitation and large irregularly shaped "native" right ventricular outflow tract. This type of anatomy represents the majority of patients who could potentially benefit from transcatheter pulmonary valve therapy. Currently approved balloon-expandable devices were not designed for this application and the unique anatomy of these patients presents tremendous challenges for designing a valve that is. This article explores those challenges and the newest self-expanding devices designed to treat this challenging population.
Collapse
Affiliation(s)
- Evan Michael Zahn
- Guerin Family Congenital Heart Program, Cedars Sinai Medical Center, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA.
| |
Collapse
|
105
|
Chen WL, Kan CD. In Vitro Hemodynamic Evaluation of Right Ventricle-Pulmonary Artery Continuity Reconstruction Through a Trileaflet Expanded Polytetrafluoroethylene Valved Conduit. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:4548-4551. [PMID: 30441363 DOI: 10.1109/embc.2018.8513179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Percutaneous pulmonary valve implantation is a technique to treat narrowed pulmonary valves or leaky pulmonary valves in congenital heart disease. This technique provides a promising strategy to reduce surgical risk. In clinical cases, due to stent size restrictions, commercial valve stents are sometimes unsuitable for children or certain patients. Hence, handmade pulmonary valved conduits prove useful because a customized size can be obtained for valve replacement. We propose a meta-learning-based intelligent model to train an estimator (including two sub-estimators) to determine optimal trileaflet parameters for customized trileaflet valve reconstruction. The purpose of this study was to investigate the hemodynamic and functional consequences of the novel design by employing a mock circulation system. We recorded the diastolic valve leakage and calculated the pulmonary regurgitation, regurgitation fraction, and ejection efficiency in a pulsatile setting. The prosthetic leaflet behavior was assessed using an endoscope camera and the pressure drops through valves were measured. All the in vitro parameters indicated that the expanded polytetrafluoroethylene (ePTFE) valved conduits were not inferior to commercial mechanical or tissue valve conduits and could decrease the regurgitation volume and increase the efficiency. Compatible early clinical outcomes were also identified between ePTFE valved conduits and other valved conduits used for right ventricular outflow tract reconstruction. The ePTFE valved conduits could be implanted in relatively small patients. An in vitro experimental study provided evidence that a handmade ePTFE valved conduit could be an attractive alternative to other commercialized valved conduits used for right ventricle-pulmonary artery continuity reconstruction.
Collapse
|
106
|
Shahanavaz S, McElhinney DB. Transcatheter pulmonary valve replacement: evolving indications and application. Future Cardiol 2018; 14:511-524. [DOI: 10.2217/fca-2018-0065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The introduction of transcatheter therapy for valvular heart disease has changed the spectrum of care of patients with a variety of cardiovascular conditions. Transcatheter valve placement has become established as a method of treating pathologic regurgitation or stenosis of the pulmonary valve, right ventricular outflow tract or a right ventricle to pulmonary artery conduit. In this review, we examine the pathophysiology of and indications for transcatheter pulmonary valve replacement along with procedural complications. Advancements in clinical application and valve technology will also be covered.
Collapse
Affiliation(s)
- Shabana Shahanavaz
- Department of Pediatrics, Division of Cardiology, Washington University in St. Louis School of Medicine, St. Louis, 63110, MO, USA
| | - Doff B McElhinney
- Departments of Pediatrics & Cardiothoracic Surgery, Lucile Packard Children’s Hospital Heart Center, Stanford University School of Medicine, Palo Alto, Stanford-94304-5731, CA, USA
| |
Collapse
|
107
|
Morrical BD, Dearani JA, Cabalka AK. Melody valve in mitral position: Complete fracture causing acute mitral stenosis in a child. Catheter Cardiovasc Interv 2018; 93:E101-E104. [DOI: 10.1002/ccd.27683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 04/30/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022]
|
108
|
Georgiev S, Tanase D, Ewert P, Meierhofer C, Hager A, von Ohain JP, Eicken A. Percutaneous pulmonary valve implantation in patients with dysfunction of a "native" right ventricular outflow tract - Mid-term results. Int J Cardiol 2018; 258:31-35. [PMID: 29544952 DOI: 10.1016/j.ijcard.2017.11.091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 11/05/2017] [Accepted: 11/27/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND To investigate the feasibility and mid-term results of percutaneous pulmonary valve implantation (PPVI) in patients with conduit free or "native" right ventricular outflow tracts (RVOT). METHODS AND RESULTS We identified all 18 patients with conduit free or "native" right ventricular outflow tract, who were treated with percutaneous pulmonary valve implantation (PPVI) in our institution. They were divided into two groups - these in whom the central pulmonary artery was used as an anchoring point for the preparation of the landing zone (n=10) for PPVI and these, in whom a pulmonary artery branch was used for this purpose (n=8). PPVI was performed successfully in all patients with significant immediate RVOT gradient and pulmonary regurgitation grade reduction. Four patients had insignificant paravalvular regurgitation. In one patient the valve was explanted after 4months because of bacterial endocarditis. A follow-up of 19 (4-60) months showed sustained good function of the other implanted valves. The MRI indexed right ventricular end diastolic volume significantly decreased from 108(54-174) ml/m2 before the procedure to 76(60-126) ml/m2 six months after PPVI, p=0.01. CONCLUSIONS PPVI is feasible with good mid-term results in selected patients with a "native" RVOT without a previously implanted conduit. Creating a stable landing zone with a diameter less than the largest available valve (currently 29mm) is crucial for the technical success of the procedure. Further studies and the development of new devices could widen the indications for this novel treatment.
Collapse
Affiliation(s)
- Stanimir Georgiev
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany.
| | - Daniel Tanase
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
| | - Christian Meierhofer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
| | | | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
| |
Collapse
|
109
|
Morgan GJ, Sadeghi S, Salem MM, Wilson N, Kay J, Rothman A, Galindo A, Martin MH, Gray R, Ross M, Aboulhosn JA, Levi DS. SAPIEN valve for percutaneous transcatheter pulmonary valve replacement without “pre‐stenting”: A multi‐institutional experience. Catheter Cardiovasc Interv 2018; 93:324-329. [DOI: 10.1002/ccd.27932] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/30/2018] [Accepted: 09/23/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Gareth J. Morgan
- Division of Pediatric CardiologyChildren's Hospital of Colorado Aurora Colorado
- Division of CardiologyUniversity of Colorado Aurora Colorado
| | - Soraya Sadeghi
- Department of Pediatrics, Division of CardiologyUCLA Mattel Children's Hospital Los Angeles California
| | - Moris M. Salem
- Department of Pediatrics, Division of CardiologyKaiser Permanente Los Angeles California
| | - Neil Wilson
- Division of Pediatric CardiologyChildren's Hospital of Colorado Aurora Colorado
| | - Joseph Kay
- Division of CardiologyUniversity of Colorado Aurora Colorado
| | - Abraham Rothman
- Division of Pediatric CardiologyChildren's Heart Center of Nevada Las Vegas Nevada
| | - Alvaro Galindo
- Division of Pediatric CardiologyChildren's Heart Center of Nevada Las Vegas Nevada
| | - Mary Hunt Martin
- Division of Pediatric CardiologyPrimary Children's Hospital Salt Lake City Utah
| | - Robert Gray
- Division of Pediatric CardiologyPrimary Children's Hospital Salt Lake City Utah
| | - Michael Ross
- Division of Pediatric CardiologyChildren's Hospital of Colorado Aurora Colorado
| | - Jamil A. Aboulhosn
- Department of Medicine, Ahmanson Adult Congenital Heart Disease CenterDavid Geffen School of Medicine at UCLA Los Angeles California
| | - Daniel Steven Levi
- Department of Pediatrics, Division of CardiologyUCLA Mattel Children's Hospital Los Angeles California
- Department of Medicine, Ahmanson Adult Congenital Heart Disease CenterDavid Geffen School of Medicine at UCLA Los Angeles California
| |
Collapse
|
110
|
Cools B, Brown S, Budts W, Heying R, Troost E, Boshoff D, Eyskens B, Gewillig M. Up to 11 years of experience with the Melody valved stent in the right ventricular outflow tract. EUROINTERVENTION 2018; 14:e988-e994. [DOI: 10.4244/eij-d-18-00054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
111
|
de Torres-Alba F, Kaleschke G, Baumgartner H. Impacto del implante percutáneo de válvula pulmonar en cuanto al momento de reintervenir por disfunción del tracto de salida del ventrículo derecho. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
112
|
Edwards SAPIEN Transcatheter Pulmonary Valve Implantation: Results From a French Registry. JACC Cardiovasc Interv 2018; 11:1909-1916. [PMID: 30219326 DOI: 10.1016/j.jcin.2018.05.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/14/2018] [Accepted: 05/22/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to describe and analyze data from patients treated in France with the Edwards SAPIEN transcatheter heart valve (Edwards Lifesciences LLC, Irvine, California) in the pulmonary position. BACKGROUND The Edwards SAPIEN valve has recently been introduced for percutaneous pulmonary valve implantation (PPVI). METHODS From April 2011 to May 2017, 71 patients undergoing PPVI were consecutively included. RESULTS The median age at PPVI was 26.8 years (range 12.8 to 70.1 years). Primary underlying diagnoses were conotruncal malformations (common arterial trunk, tetralogy of Fallot and variants; n = 45), Ross procedure (n = 18), and other diagnoses (n = 8). PPVI indication was pure stenosis in 33.8% of patients, pure regurgitation in 28.1%, and mixed lesions in 38.1%. PPVI was successfully implemented in 68 patients (95.8%). Pre-stenting of the right ventricular outflow tract was performed in 70 patients (98.6%). Early major complications occurred in 4 subjects (5.6%), including 1 death, 1 coronary compression, and 2 pulmonary valve embolizations. Three of the 4 major complications occurred in the first 15 operated patients. No significant regurgitation was recorded after the procedure. Transpulmonary gradient was significantly reduced from 34.5 to 10.5 mm Hg (p < 0.0001). No patient died during a 1-month follow-up period. At 1-year follow-up, the death rate was 2.9%, and 3 patients had undergone surgical reintervention (44%). CONCLUSIONS Early results with the Edwards SAPIEN valve in the pulmonary position demonstrate an ongoing high rate of procedural success.
Collapse
|
113
|
Transcatheter Valve Procedures and the Anesthesiologist. Int Anesthesiol Clin 2018; 56:74-97. [PMID: 30204609 DOI: 10.1097/aia.0000000000000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
114
|
Sharma V, Griffiths ER, Eckhauser AW, Gray RG, Martin MH, Zhang C, Presson AP, Burch PT. Pulmonary Valve Replacement: A Single-Institution Comparison of Surgical and Transcatheter Valves. Ann Thorac Surg 2018; 106:807-813. [DOI: 10.1016/j.athoracsur.2018.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/07/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
|
115
|
Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:e81-e192. [PMID: 30121239 DOI: 10.1016/j.jacc.2018.08.1029] [Citation(s) in RCA: 484] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
116
|
2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:1494-1563. [PMID: 30121240 DOI: 10.1016/j.jacc.2018.08.1028] [Citation(s) in RCA: 312] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
117
|
Martin MH, Meadows J, McElhinney DB, Goldstein BH, Bergersen L, Qureshi AM, Shahanavaz S, Aboulhosn J, Berman D, Peng L, Gillespie M, Armstrong A, Weng C, Minich LL, Gray RG. Safety and Feasibility of Melody Transcatheter Pulmonary Valve Replacement in the Native Right Ventricular Outflow Tract. JACC Cardiovasc Interv 2018; 11:1642-1650. [DOI: 10.1016/j.jcin.2018.05.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/07/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
|
118
|
Tanase D, Ewert P, Hager A, Georgiev S, Cleuziou J, Hess J, Eicken A. Infective endocarditis after percutaneous pulmonary valve implantation – A long-term single centre experience. Int J Cardiol 2018; 265:47-51. [DOI: 10.1016/j.ijcard.2018.04.094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/04/2018] [Accepted: 04/20/2018] [Indexed: 12/25/2022]
|
119
|
Andresen B, Døhlen G, Diep LM, Lindberg H, Fosse E, Andersen MH. Psychosocial and clinical outcomes of percutaneous versus surgical pulmonary valve implantation. Open Heart 2018; 5:e000758. [PMID: 30018768 PMCID: PMC6045705 DOI: 10.1136/openhrt-2017-000758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/21/2018] [Accepted: 03/06/2018] [Indexed: 11/23/2022] Open
Abstract
Objective This prospective non-randomised study was performed to compare the psychosocial function and clinical outcomes following surgical and percutaneous implantation of a pulmonary valve at 3 months and 1 year after treatment. Methods All patients were consecutively admitted for treatment by either method from June 2011 to October 2014. The data of 20 patients treated with the percutaneous technique and 14 patients treated with open heart surgery were compared. Psychosocial function was measured by the Achenbach System of Empirically Based Assessment (ASEBA). We used linear mixed-effect models to investigate group changes between the psychosocial function and clinical data of 34 patients with congenital pulmonary valve disease. Results A significant difference in favour of the percutaneous pulmonary valve implantation group was observed regarding the ASEBA scores, specifically in the Thought problems subscale at 1 year (p=0.015), Attention problems subscale at 3 months (p=0.016) and 1 year (p=0.007) after treatment. After adjustment for the right ventricle to pulmonary artery pressure gradient at 3 months, a significant change in the Attention problems subscale (p=0.038) was noted in the percutaneous group. The New York Heart Association functional score significantly improved in both groups. The measured right ventricle to pulmonary artery pressure gradient was reduced significantly in both groups at 1 year. Conclusions Both methods led to significant clinical improvement. Thought and attention problems such as intrusive behaviour significantly decreased only in patients who underwent the percutaneous procedure. Complications as reintervention, bleeding and arrhythmia were only observed in the open surgery group.
Collapse
Affiliation(s)
- Brith Andresen
- Intervention Centre, Oslo University Hospital, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gaute Døhlen
- Department of Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Lien My Diep
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Harald Lindberg
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Erik Fosse
- Intervention Centre, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marit Helen Andersen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
120
|
Corno AF. Pulmonary Valve Regurgitation: Neither Interventional Nor Surgery Fits All. Front Pediatr 2018; 6:169. [PMID: 29951475 PMCID: PMC6008531 DOI: 10.3389/fped.2018.00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/22/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction: PV implantation is indicated for severe PV regurgitation after surgery for congenital heart defects, but debates accompany the following issues: timing of PV implantation; choice of the approach, percutaneous interventional vs. surgical PV implantation, and choice of the most suitable valve. Timing of pulmonary valve implantation: The presence of symptoms is class I evidence indication for PV implantation. In asymptomatic patients indication is agreed for any of the following criteria: PV regurgitation > 20%, indexed end-diastolic right ventricular volume > 120-150 ml/m2 BSA, and indexed end-systolic right ventricular volume > 80-90 ml/m2 BSA. Choice of the approach: percutaneous interventional vs. surgical: The choice of the approach depends upon the morphology and the size of the right ventricular outflow tract, the morphology and the size of the pulmonary arteries, the presence of residual intra-cardiac defects and the presence of extremely dilated right ventricle. Choice of the most suitable valve for surgical implantation: Biological valves are first choice in most of the reported studies. A relatively large size of the biological prosthesis presents the advantage of avoiding a right ventricular outflow tract obstruction, and also of allowing for future percutaneous valve-in-valve implantation. Alternatively, biological valved conduits can be implanted between the right ventricle and pulmonary artery, particularly when a reconstruction of the main pulmonary artery and/or its branches is required. Hybrid options: combination of interventional and surgical: Many progresses extended the implantation of a PV with combined hybrid interventional and surgical approaches. Major efforts have been made to overcome the current limits of percutaneous PV implantation, namely the excessive size of a dilated right ventricular outflow tract and the absence of a cylindrical geometry of the right ventricular outflow tract as a suitable landing for a percutaneous PV implantation. Conclusion: Despite tremendous progress obtained with modern technologies, and the endless fantasy of researchers trying to explore new forms of treatment, it is too early to say that either the interventional or the surgical approach to implant a PV can fit all patients with good long-term results.
Collapse
Affiliation(s)
- Antonio F. Corno
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, United Kingdom
- Cardiovascular Research Center, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
121
|
de Torres-Alba F, Kaleschke G, Baumgartner H. Impact of Percutaneous Pulmonary Valve Implantation on the Timing of Reintervention for Right Ventricular Outflow Tract Dysfunction. ACTA ACUST UNITED AC 2018; 71:838-846. [PMID: 29859895 DOI: 10.1016/j.rec.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/23/2018] [Indexed: 02/07/2023]
Abstract
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect. Early surgical repair has dramatically improved the outcome of this condition. However, despite the success of contemporary approaches with early complete repair, these are far from being curative and late complications are frequent. The most common complication is right ventricle outflow tract (RVOT) dysfunction, affecting most patients in the form of pulmonary regurgitation, pulmonary stenosis, or both, and can lead to development of symptoms of exercise intolerance, arrhythmias, and sudden cardiac death. Optimal timing of restoration of RVOT functionality in asymptomatic patients with RVOT dysfunction after TOF repair is still a matter of debate. Percutaneous pulmonary valve implantation, introduced almost 2 decades ago, has become a major game-changer in the treatment of RVOT dysfunction. In this article we review the pathophysiology, the current indications, and treatment options for RVOT dysfunction in patients after TOF repair with a focus on the role of percutaneous pulmonary valve implantation in the therapeutic approach to these patients.
Collapse
Affiliation(s)
- Fernando de Torres-Alba
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
| | - Gerrit Kaleschke
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Helmut Baumgartner
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
122
|
Abstract
We report on successful endovascular retrieval of an accidentally flared Melody valve in an adult patient with an indication for percutaneous pulmonary valve implantation. The Melody valve was removed through a 24 F sheath, introduced via the right jugular vein, and the urgent open-heart surgery was avoided.
Collapse
|
123
|
Suradi HS, Hijazi ZM. Editorial: Percutaneous pulmonary valve implantation: Better technology is on the way! J Interv Cardiol 2018; 31:261-263. [PMID: 29644754 DOI: 10.1111/joic.12488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 12/01/2017] [Accepted: 12/07/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hussam S Suradi
- St. Mary Medical Center, Hobart, IN and Rush Center for Structural Heart Disease, Rush University Medical Center, Chicago, Illinois
| | - Ziyad M Hijazi
- Weill Cornell Medicine, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| |
Collapse
|
124
|
Cigarroa R, Elmariah S. Anticoagulation Management After Transcatheter and Surgical Valve Replacement. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:42. [DOI: 10.1007/s11936-018-0629-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
125
|
Wadia SK, Lluri G, Aboulhosn JA, Shivkumar K, Reemtsen BL, Laks H, Biniwale RM, Levi DS, Salem M, Moore JP. Ventricular arrhythmia burden after transcatheter versus surgical pulmonary valve replacement. Heart 2018; 104:1791-1796. [DOI: 10.1136/heartjnl-2017-312769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/21/2018] [Accepted: 03/23/2018] [Indexed: 01/29/2023] Open
Abstract
ObjectiveComparative ventricular arrhythmia (VA) outcomes following transcatheter (TC-PVR) or surgical pulmonary valve replacement (S-PVR) have not been evaluated. We sought to compare differences in VAs among patients with congenital heart disease (CHD) following TC-PVR or S-PVR.MethodsPatients with repaired CHD who underwent TC-PVR or S-PVR at the UCLA Medical Center from 2010 to 2016 were analysed retrospectively. Patients who underwent hybrid TC-PVR or had a diagnosis of congenitally corrected transposition of the great arteries were excluded. Patients were screened for a composite of non-intraoperative VA (the primary outcome variable), defined as symptomatic/recurrent non-sustained ventricular tachycardia (VT) requiring therapy, sustained VT or ventricular fibrillation. VA epochs were classified as 0–1 month (short-term), 1–12 months (mid-term) and ≥1 year (late-term).ResultsThree hundred and two patients (TC-PVR, n=172 and S-PVR, n=130) were included. TC-PVR relative to S-PVR was associated with fewer clinically significant VAs in the first 30 days after valve implant (adjusted HR 0.20, p=0.002), but similar mid-term and late-term risks (adjusted HR 0.72, p=0.62 and adjusted HR 0.47, p=0.26, respectively). In propensity-adjusted models, S-PVR, patient age at PVR and native right ventricular outflow tract (RVOT) (vs bioprosthetic/conduit outflow tract) were independent predictors of early VA after pulmonary valve implantation (p<0.05 for all).ConclusionCompared with S-PVR, TC-PVR was associated with reduced short-term but comparable mid-term and late-term VA burdens. Risk factors for VA after PVR included a surgical approach, valve implantation into a native RVOT and older age at PVR.
Collapse
|
126
|
Zampi JD, Whiteside W. Innovative interventional catheterization techniques for congenital heart disease. Transl Pediatr 2018; 7:104-119. [PMID: 29770292 PMCID: PMC5938250 DOI: 10.21037/tp.2017.12.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/01/2017] [Indexed: 11/06/2022] Open
Abstract
Since 1929, when the first cardiac catheterization was safely performed in a human by Dr. Werner Forssmann (on himself), there has been a rapid progression of cardiac catheterization techniques and technologies. Today, these advances allow us to treat a wide variety of patients with congenital heart disease using minimally invasive techniques; from fetus to infants to adults, and from simple to complex congenital cardiac lesions. In this article, we will explore some of the exciting advances in cardiac catheterization for the treatment of congenital heart disease, including transcatheter valve implantation, hybrid procedures, biodegradable technologies, and magnetic resonance imaging (MRI)-guided catheterization. Additionally, we will discuss innovations in imaging in the catheterization laboratory, including 3D rotational angiography (3DRA), fusion imaging, and 3D printing, which help to make innovative interventional approaches possible.
Collapse
Affiliation(s)
- Jeffrey D Zampi
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Wendy Whiteside
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| |
Collapse
|
127
|
Solana-Gracia R, Rueda F, Betrián P, Gutiérrez-Larraya F, del Cerro MJ, Pan M, Alcíbar J, Coserría JF, Velasco JM, Zunzunegui JL. Registro español de implante percutáneo de la válvula pulmonar Melody en menores de 18 años. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
128
|
Pulmonary reinterventions after complete unifocalization and repair in infants and young children with tetralogy of Fallot with major aortopulmonary collaterals. J Thorac Cardiovasc Surg 2018; 155:1696-1707. [DOI: 10.1016/j.jtcvs.2017.11.086] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 11/09/2017] [Accepted: 11/19/2017] [Indexed: 11/20/2022]
|
129
|
Cabalka AK, Asnes JD, Balzer DT, Cheatham JP, Gillespie MJ, Jones TK, Justino H, Kim DW, Lung TH, Turner DR, McElhinney DB. Transcatheter pulmonary valve replacement using the melody valve for treatment of dysfunctional surgical bioprostheses: A multicenter study. J Thorac Cardiovasc Surg 2018; 155:1712-1724.e1. [DOI: 10.1016/j.jtcvs.2017.10.143] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/21/2017] [Accepted: 10/14/2017] [Indexed: 10/18/2022]
|
130
|
Abstract
The field of pediatric and adult congenital cardiac catheterization has evolved rapidly in recent years. This review will focus on some of the newer endovascular technological and management strategies now being applied in the pediatric interventional laboratory. Emerging imaging techniques such as three-dimensional (3D) rotational angiography, multi-modal image fusion, 3D printing, and holographic imaging have the potential to enhance our understanding of complex congenital heart lesions for diagnostic or interventional purposes. While fluoroscopy and standard angiography remain procedural cornerstones, improved equipment design has allowed for effective radiation exposure reduction strategies. Innovations in device design and implantation techniques have enabled the application of percutaneous therapies in a wider range of patients, especially those with prohibitive surgical risk. For example, there is growing experience in transcatheter duct occlusion in symptomatic low-weight or premature infants and stent implantation into the right ventricular outflow tract or arterial duct in cyanotic neonates with duct-dependent pulmonary circulations. The application of percutaneous pulmonary valve implantation has been extended to a broader patient population with dysfunctional ‘native’ right ventricular outflow tracts and has spurred the development of novel techniques and devices to solve associated anatomic challenges. Finally, hybrid strategies, combining cardiosurgical and interventional approaches, have enhanced our capabilities to provide care for those with the most complex of lesions while optimizing efficacy and safety.
Collapse
Affiliation(s)
- Sok-Leng Kang
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, The Labatt Family Heart Center, The University of Toronto School of Medicine, Toronto, Canada.,Department of Pediatric Cardiology, Bristol Royal Hospital for Children, Bristol, BS2 OJJ, UK
| | - Lee Benson
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, The Labatt Family Heart Center, The University of Toronto School of Medicine, Toronto, Canada
| |
Collapse
|
131
|
Motta SE, Fioretta ES, Dijkman PE, Lintas V, Behr L, Hoerstrup SP, Emmert MY. Development of an Off-the-Shelf Tissue-Engineered Sinus Valve for Transcatheter Pulmonary Valve Replacement: a Proof-of-Concept Study. J Cardiovasc Transl Res 2018; 11:182-191. [PMID: 29560553 DOI: 10.1007/s12265-018-9800-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/05/2018] [Indexed: 11/30/2022]
Abstract
Tissue-engineered heart valves with self-repair and regeneration properties may overcome the problem of long-term degeneration of currently used artificial prostheses. The aim of this study was the development and in vivo proof-of-concept of next-generation off-the-shelf tissue-engineered sinus valve (TESV) for transcatheter pulmonary valve replacement (TPVR). Transcatheter implantation of off-the-shelf TESVs was performed in a translational sheep model for up to 16 weeks. Transapical delivery of TESVs was successful and showed good acute and short-term performance (up to 8 weeks), which then worsened over time most likely due to a non-optimized in vitro valve design. Post-mortem analyses confirmed the remodelling potential of the TESVs, with host cell infiltration, polymer degradation, and collagen and elastin deposition. TESVs proved to be suitable as TPVR in a preclinical model, with encouraging short-term performance and remodelling potential. Future studies will enhance the clinical translation of such approach by improving the valve design to ensure long-term functionality.
Collapse
Affiliation(s)
- Sarah E Motta
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Emanuela S Fioretta
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Petra E Dijkman
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Valentina Lintas
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Luc Behr
- Institute Mutualiste Montsouris (IMMR), Paris, France
| | - Simon P Hoerstrup
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland.,Wyss Translational Center Zurich, University and ETH Zurich, Zurich, Switzerland
| | - Maximilian Y Emmert
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland. .,Wyss Translational Center Zurich, University and ETH Zurich, Zurich, Switzerland. .,Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.
| |
Collapse
|
132
|
Abstract
PURPOSE OF REVIEW The past couple of decades have brought tremendous advances to the field of pediatric and adult congenital heart disease (CHD). Percutaneous valve interventions are now a cornerstone of not just the congenital cardiologist treating patients with congenital heart disease, but also-and numerically more importantly-for adult interventional cardiologists treating patients with acquired heart valve disease. 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 right ventricular outflow tract (RVOT) dysfunction. This review aims to summarize (1) the current state of the art for tPVR, (2) the expanding indications, and (3) the technological obstacles to optimizing tPVR. RECENT FINDINGS Since its introduction in 2000, more than ten thousands tPVR procedures have been performed worldwide. Although the indications for tPVR have been adapted earlier from those accepted for surgical intervention, they remain incompletely defined. The new imaging modalities give better assessment of cardiac anatomy and function and determine candidacy for the procedure. The procedure has been shown to be feasible and safe when performed in patients who received pulmonary conduit and or bioprosthetic valves between the right ventricle and the pulmonary artery. Fewer selected patients post trans-annular patch repair for tetralogy of Fallot may also be candidates for this technology. Size restrictions of the currently available valves limit deployment in the majority of patients post trans-annular patch repair. Newer valves and techniques are being developed that may help such patients. Refinements and further developments of this procedure hold promise for the extension of this technology to other patient populations.
Collapse
|
133
|
Zimmermann C, Attenhofer Jost C, Prêtre R, Mueller C, Greutmann M, Seifert B, Valsangiacomo Büchel E, Kretschmar O, Dave HH, Weber R. Mid-term Outcome of 100 Consecutive Ross Procedures: Excellent Survival, But Yet to Be a Cure. Pediatr Cardiol 2018; 39:595-603. [PMID: 29327146 DOI: 10.1007/s00246-017-1798-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/22/2017] [Indexed: 11/24/2022]
Abstract
The Ross procedure offers excellent short-term outcome but the long-term durability is under debate. Reinterventions and follow-up of 100 consecutive patients undergoing Ross Procedure at our centre (1993-2011) were analysed. Follow-up was available for 96 patients (97%) with a median duration of 5.3 (0.1-17.1) years. Median age of the patient cohort was 15.2 (0.04-58.4) years with 76 males. 93% had underlying congenital aortic stenosis. Root replacement technique was applied in all. The most common valved conduits used for reconstruction of the right ventricular outflow tract were homografts (66 patients) and bovine jugular vein (ContegraR) graft (31 patients). Additional procedures included Ross-Konno procedure (14%), resection of subaortic stenosis/myectomy (11%) and reduction plasty of the ascending aorta (25%). One patient died within the first 30 days (1%). Late deaths occurred in 4 patients (4%) 0.5-4.5 years postoperatively: causes included pulmonary hypertension due to endocardial fibroelastosis (2), subarachnoid haemorrhage (1) and sudden cardiac death (1). Five-year survival was 93.6 (95% CI 88.1-99.1)%. Moderate or severe aortic (autograft) regurgitation needing reoperation occurred in 8 patients with a 5-year freedom from autograft reoperation of 98.5 (95.6-100)%. Five-year freedom from reintervention (surgery or catheter based) on the right ventricular outflow tract conduit was 91.5 (85.5-96.5)%. Univariate predictors of this reinterventions were smaller graft size (p = 0.03) and use of a ContegraR graft (p = 0.04). Ross procedure can be performed with low mortality and good survival in the long term. Most of the reinterventions are related to the neo-right ventricular outflow tract and may be partly attributed to the lack of growth. While the Ross Procedure remains an invaluable option for aortic valve disease in children, new solutions for the neo-pulmonary valve as well as for the less often occurring problems on the autograft are needed.
Collapse
Affiliation(s)
- Corina Zimmermann
- Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University of Zurich, Zurich, Switzerland
| | | | - René Prêtre
- Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Centre, University of Zurich, Zurich, Switzerland
| | - Christoph Mueller
- Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Centre, University of Zurich, Zurich, Switzerland
| | | | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Emanuela Valsangiacomo Büchel
- Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University of Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University of Zurich, Zurich, Switzerland
| | - Hitendu Hasmukhlal Dave
- Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Centre, University of Zurich, Zurich, Switzerland
| | - Roland Weber
- Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland. .,Children's Research Centre, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
134
|
Bartra S. Transcatheter Pulmonary Valve Replacement in Patients With Congenital Heart Disease. Crit Care Nurse 2018; 38:30-36. [PMID: 29437076 DOI: 10.4037/ccn2018581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Transcatheter pulmonary valve replacement is now a feasible alternative to surgical pulmonary valve replacement in children and adults with dysfunctional right ventricular outflow conduits. Currently, 2 types of valves can be used for this application. This article provides an overview of the procedure and how it is performed, indications and contraindications for transcatheter pulmonary valve replacement, and short- and long-term outcomes. Nursing considerations mainly focus on educating patients, preventing bleeding and infection, monitoring renal function, and preventing injury to the catheter insertion site. This article enhances the knowledge of nurses working in cardiac catheterization laboratories and post-procedure recovery and cardiac units so that the nurses can anticipate interventions and understand the management of patients who have transcatheter pulmonary valve replacement.
Collapse
Affiliation(s)
- Shantelle Bartra
- Shantelle Bartra is a pediatric nurse practitioner and coordinator in the cardiac catheterization laboratory, Congenital Heart Center, University of Florida Health, Shands Hospital, Gainesville, Florida.
| |
Collapse
|
135
|
Cools B, Brown S, Wevers M, Humbeeck JV, Boshoff D, Verdonckt C, Gewillig M. Right ventricle outflow tract prestenting: In vitro testing of rigidity and corrosion properties. Catheter Cardiovasc Interv 2018; 91:285-291. [PMID: 28895283 DOI: 10.1002/ccd.27320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/20/2017] [Accepted: 08/05/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to assess the resistance to compression (stiffness) of frequently used stents for right ventricular outflow tract prestenting. In addition, to assess the corrosion potential when different types of stent alloys come into contact with each other. METHOD Different stents were tested in vitro in various combinations at specialized metallurgic laboratories. A bench compression test was used to assess resistance to compression of singular and joined combinations of stents. Corrosion was evaluated by standardized electrochemical galvanic tests in physiological solutions at 37°C. Single stents and combinations of stents were evaluated over a period of 4-12 weeks. RESULTS Relative stiffness of the stents Optimus/Andrastent XXL/Intrastent LD Max/8zig Cheatham-Platinum, expressed as load per length to deform the stent for 1 mm at 22 mm was 100/104/161/190. Adding additional stents to a single stent significantly strengthened the joined couples (P < 0.001). The lowest galvanic corrosion rates (about 0.000001 mm/year) were observed for the joined CP-Andrastent, Andra-Sapien, and Andra-SapienXT. The corrosion rate for coupled CP-Sapien and CP-SapienXT was somewhat higher (about 0.000003 mm/year). The materials with the highest corrosion rates resulted in material losses of, respectively, 17 and 24 µg/year, which is negligible over a lifetime. CONCLUSION Adding stents to a single stent significantly increases stiffness which will reduce the risk of metal fatigue failure. Corrosion of individual stents or stent combinations occurs, but is negligible over a human lifetime with low risk of biological effects. No mechanical integrity problems are thus expected as there is only 0.3% of the initial diameter of the struts of a stent that will be lost as a consequence of corrosion after 100 years.
Collapse
Affiliation(s)
- Bjorn Cools
- Pediatric and Congenital Cardiology, UZ Leuven, Leuven, Belgium
| | - Stephen Brown
- Pediatric and Congenital Cardiology, UZ Leuven, Leuven, Belgium.,Pediatric Cardiology, University of the Free State, Bloemfontein, South Africa
| | - Martine Wevers
- Department of Metallurgy and Materials Engineering, University of Leuven, Leuven, Belgium
| | - Jan Van Humbeeck
- Department of Metallurgy and Materials Engineering, University of Leuven, Leuven, Belgium
| | - Derize Boshoff
- Pediatric and Congenital Cardiology, UZ Leuven, Leuven, Belgium
| | - Cis Verdonckt
- Corrosion Engineering, Metalogic, Rotselaar, Belgium
| | - Marc Gewillig
- Pediatric and Congenital Cardiology, UZ Leuven, Leuven, Belgium
| |
Collapse
|
136
|
Gregory SH, Zoller JK, Shahanavaz S, Chilson KL, Ridley CH. Anesthetic Considerations for Transcatheter Pulmonary Valve Replacement. J Cardiothorac Vasc Anesth 2018; 32:402-411. [DOI: 10.1053/j.jvca.2017.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Indexed: 12/27/2022]
|
137
|
Haas NA, Carere RG, Kretschmar O, Horlick E, Rodés-Cabau J, de Wolf D, Gewillig M, Mullen M, Lehner A, Deutsch C, Bramlage P, Ewert P. Early outcomes of percutaneous pulmonary valve implantation using the Edwards SAPIEN XT transcatheter heart valve system. Int J Cardiol 2018; 250:86-91. [DOI: 10.1016/j.ijcard.2017.10.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/14/2017] [Accepted: 10/03/2017] [Indexed: 11/28/2022]
|
138
|
Simmons MA, Elder RW, Shabanova V, Hellenbrand W, Asnes J. Ventricular arrhythmias immediately following transcatheter pulmonary valve implantation: A cause for concern? Catheter Cardiovasc Interv 2017; 91:920-926. [DOI: 10.1002/ccd.27454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/27/2017] [Accepted: 12/04/2017] [Indexed: 11/08/2022]
Affiliation(s)
- M. Abigail Simmons
- Section of Pediatric Cardiology, Department of PediatricsYale University School of Medicine New Haven Connecticut
| | - Robert W. Elder
- Section of Pediatric Cardiology, Department of PediatricsYale University School of Medicine New Haven Connecticut
| | - Veronika Shabanova
- Department of PediatricsYale University School of MedicineNew Haven Connecticut
| | - William Hellenbrand
- Section of Pediatric Cardiology, Department of PediatricsYale University School of Medicine New Haven Connecticut
| | - Jeremy Asnes
- Section of Pediatric Cardiology, Department of PediatricsYale University School of Medicine New Haven Connecticut
| |
Collapse
|
139
|
Oechslin L, Corti R, Greutmann M, Kretschmar O, Gaemperli O. Percutaneous pulmonary valve implantation in grown-up congenital heart disease patients: Insights from the Zurich experience. J Interv Cardiol 2017; 31:251-260. [PMID: 29277931 DOI: 10.1111/joic.12477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/14/2017] [Accepted: 11/14/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES The aim of the study was to assess indications, procedural success, complications, echocardiographic, and clinical outcomes of percutaneous pulmonary valve implantation (PPVI) in adult patients with congenital heart disease (CHD). BACKGROUND PPVI offers a non-surgical treatment option for failing prosthetic conduits in pulmonary position. However, efficacy and clinical outcomes after PPVI are still underreported. METHODS From January 2008 to March 2016, 25 adult CHD patients with right ventricular outflow tract (RVOT) stenosis and/or pulmonary regurgitation underwent PPVI in our institution. Clinical and echocardiographic data was collected at baseline, at 12 months of follow-up and yearly afterwards. RESULTS Tetralogy of Fallot and repaired pulmonary atresia were among the most prevalent underlying congenital defects. Twenty-one (84%) received a Medtronic Melody® and four (16%) patients an Edwards Sapien valve prosthesis. The PPVI procedure was successful in all 25 patients. Pre-stenting was performed in all but two (8%) patients. PPVI reduced peak-to-peak pulmonary valve gradient from 43 (IQR 28-60) mmHg to 16 (IQR 14-22) mmHg (P < 0.001). Periprocedural complications occurred in two (8%) patients (tricuspid valve damage, pulmonary artery perforation). Over a median follow-up of 43 (IQR 18-58) months all patients were alive. Only two (8%) required re-operation and two (8%) developed stent fractures (one of them had not undergone pre-stenting). NYHA functional class improved significantly, with 20 (80%) patients in NYHA class I on follow-up. CONCLUSIONS PPVI with Medtronic Melody or Edwards Sapien valve conduits is safe and provides effective relief from right ventricular outflow tract obstruction or pulmonary regurgitation.
Collapse
Affiliation(s)
| | | | | | - Oliver Kretschmar
- Division of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland
| | | |
Collapse
|
140
|
Hascoet S, Martins JD, Baho H, Kadirova S, Pinto F, Paoli F, Bitar F, Haweleh AA, Uebing A, Acar P, Ghez O, Fraisse A. Percutaneous pulmonary valve implantation in small conduits: A multicenter experience. Int J Cardiol 2017; 254:64-68. [PMID: 29273239 DOI: 10.1016/j.ijcard.2017.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 09/25/2017] [Accepted: 12/01/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Guidelines allow percutaneous pulmonary valve implantation (PPVI) in conduits above 16mm diameter. Balloon dilatation of a conduit to a diameter>110% of the original implant size is also not recommended. We analyzed patients undergoing PPVI in such conditions. METHODS AND RESULTS Nine patients (May 2008-July 2016) from 8 institutions underwent PPVI in conduits <16mm diameter. Five patients with 16-18mm conduit diameter underwent PPVI after over-expansion of the conduit>110%. Mean age and weight of the 14 patients was 12.1 (7.7 to 16) years and 44.9 (19 to 83) kg. Median conduit diameter at PPVI was 12 (10 to 17) mm. Median systolic right ventricular pressure was 70 (40 to 94) mmHg. Procedure was successful in all cases. A confined conduit rupture occurred in 7 patients (50%) and was treated with covered stent in 6. One patient experienced dislocation of 2 pulmonary artery stents that were parked distally. The post-implantation median systolic right ventricular pressure was 36 (28 to 51) mmHg. A fistula between right-ventricle outflow and aorta was found in one patient, secondary to undiagnosed conduit rupture. This was closed surgically. After a median follow-up of 20.16 (6.95 to 103.61) months, all the patients are asymptomatic with no significant RVOT stenosis. CONCLUSIONS PPVI is feasible in small conduits but rate of ruptures is high. Although such ruptures remain contained and can be managed with covered stents in our experience, careful selection of patients and high level of expertise are necessary. More studies are needed to better assess the risk of PPVI in this population.
Collapse
Affiliation(s)
- Sebastien Hascoet
- Hôpital des enfants, Cardiologie pédiatrique, Centre de Compétence Malformations Congénitales Complexes M3C, CHU Toulouse, 31100 Toulouse, France; Hôpital Marie Lannelongue, Pôle de cardiopathies congénitales de l'enfant et de l'adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C- 92350 Le Plessis-Robinson, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, France; Inserm/UPS UMR 1048 - I2MC, CHU Toulouse, Toulouse, France
| | - José Diogo Martins
- Pediatric Cardiology Department, Hospital de Santa Marta, CHLC, Lisboa, Portugal
| | - Haysam Baho
- King Faycal Specialist Hospital, Jeddah, Saudi Arabia
| | - Saule Kadirova
- National Research Cardiac Surgery Center, Astana, Kazakhstan
| | - Fatima Pinto
- Pediatric Cardiology Department, Hospital de Santa Marta, CHLC, Lisboa, Portugal
| | | | - Fadi Bitar
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Anselm Uebing
- Royal Brompton and Harefield Hospitals Trust, London, UK
| | - Philippe Acar
- Hôpital des enfants, Cardiologie pédiatrique, Centre de Compétence Malformations Congénitales Complexes M3C, CHU Toulouse, 31100 Toulouse, France
| | - Olivier Ghez
- Royal Brompton and Harefield Hospitals Trust, London, UK
| | - Alain Fraisse
- Royal Brompton and Harefield Hospitals Trust, London, UK.
| |
Collapse
|
141
|
Biventricular Heart Remodeling After Percutaneous or Surgical Pulmonary Valve Implantation. J Thorac Imaging 2017; 32:358-364. [DOI: 10.1097/rti.0000000000000272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
142
|
Andresen B, Mishra V, Lewandowska M, Andersen JG, Andersen MH, Lindberg H, Døhlen G, Fosse E. In-hospital cost comparison between percutaneous pulmonary valve implantation and surgery. Eur J Cardiothorac Surg 2017; 51:747-753. [PMID: 28007875 PMCID: PMC5400023 DOI: 10.1093/ejcts/ezw378] [Citation(s) in RCA: 4] [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: 07/14/2016] [Accepted: 10/19/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES: Today, both surgical and percutaneous techniques are available for pulmonary valve implantation in patients with right ventricle outflow tract obstruction or insufficiency. In this controlled, non-randomized study the hospital costs per patient of the two treatment options were identified and compared. METHODS: During the period of June 2011 until October 2014 cost data in 20 patients treated with the percutaneous technique and 14 patients treated with open surgery were consecutively included. Two methods for cost analysis were used, a retrospective average cost estimate (overhead costs) and a direct prospective detailed cost acquisition related to each individual patient (patient-specific costs). RESULTS: The equipment cost, particularly the stents and valve itself was by far the main cost-driving factor in the percutaneous pulmonary valve group, representing 96% of the direct costs, whereas in the open surgery group the main costs derived from the postoperative care and particularly the stay in the intensive care department. The device-related cost in this group represented 13.5% of the direct costs. Length-of-stay-related costs in the percutaneous group were mean $3885 (1618) and mean $17 848 (5060) in the open surgery group. The difference in postoperative stay between the groups was statistically significant (P≤ 0.001). CONCLUSIONS: Given the high postoperative cost in open surgery, the percutaneous procedure could be cost saving even with a device cost of more than five times the cost of the surgical device.
Collapse
Affiliation(s)
- Brith Andresen
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Vinod Mishra
- Department of Finance and Resource Management Unit, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Jack Gunnar Andersen
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Marit Helen Andersen
- Division of Surgery, Inflammation Medicine and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Harald Lindberg
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gaute Døhlen
- Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik Fosse
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
143
|
Solana-Gracia R, Rueda F, Betrián P, Gutiérrez-Larraya F, Del Cerro MJ, Pan M, Alcíbar J, Coserría JF, Velasco JM, Zunzunegui JL. Pediatrics Spanish Registry of Percutaneous Melody Pulmonary Valve Implantation in Patients Younger Than 18 Years. ACTA ACUST UNITED AC 2017; 71:283-290. [PMID: 29042164 DOI: 10.1016/j.rec.2017.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/06/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES A decade has passed since the first Spanish percutaneous pulmonary Melody valve implant (PPVI) in March 2007. Our objective was to analyze its results in terms of valvular function and possible mid-term follow-up complications. METHODS Spanish retrospective descriptive multicenter analysis of Melody PPVI in patients < 18 years from the first implant in March 2007 until January 1, 2016. RESULTS Nine centers were recruited with a total of 81 PPVI in 77 pediatric patients, whose median age and weight were 13.3 years (interquartile range [IQR], 9.9-15.4) and 46kg (IQR, 27-63). The predominant cardiac malformation was tetralogy of Fallot (n = 27). Most of the valves were implanted on conduits, especially bovine xenografts (n = 31). The incidence of intraprocedure and acute complications was 6% and 8%, respectively (there were no periprocedural deaths). The median follow-up time was 2.4 years (IQR, 1.1-4.9). Infective endocarditis (IE) was diagnosed in 4 patients (5.6%), of which 3 required surgical valve explant. During follow-up, the EI-related mortality rate was 1.3%. At 5 years of follow-up, 80% ± 6.9% and 83% ± 6.1% of the patients were free from reintervention and pulmonary valve replacement. CONCLUSIONS Melody PPVI was safe and effective in pediatric patients with good short- and mid-term follow-up hemodynamic results. The incidence of IE during follow-up was relatively low but was still the main complication.
Collapse
Affiliation(s)
- Ruth Solana-Gracia
- Unidad de Cardiología Infantil, Hospital Universitario Infanta Leonor, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Fernando Rueda
- Unidad de Cardiología Infantil, Hospital Universitario A Coruña, A Coruña, Spain
| | - Pedro Betrián
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - María Jesús Del Cerro
- Servicio de Cardiología Infantil, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Juan Alcíbar
- Servicio de Cardiología, Hospital Universitario de Cruces, Bilbao, Vizcaya, Spain
| | | | - José Manuel Velasco
- Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Luis Zunzunegui
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Unidad de Cardiología Infantil, Hospital Universitario Gregorio Marañón, Madrid, Spain
| |
Collapse
|
144
|
Bensemlali M, Malekzadeh-Milani S, Mostefa-Kara M, Bonnet D, Boudjemline Y. Percutaneous pulmonary Melody® valve implantation in small conduits. Arch Cardiovasc Dis 2017; 110:517-524. [DOI: 10.1016/j.acvd.2016.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 09/03/2016] [Accepted: 12/15/2016] [Indexed: 11/25/2022]
|
145
|
Markham R, Challa A, Kyranis S, Nicolae M, Murdoch D, Savage M, Malpas T, Radford DJ, Hamilton-Craig C, Walters DL. Outcomes Following Melody Transcatheter Pulmonary Valve Implantation for Right Ventricular Outflow Tract Dysfunction in Repaired Congenital Heart Disease: First Reported Australian Single Centre Experience. Heart Lung Circ 2017; 26:1085-1093. [DOI: 10.1016/j.hlc.2016.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/28/2016] [Accepted: 12/07/2016] [Indexed: 11/29/2022]
|
146
|
Jeong HI, Song J, Choi EY, Kim SH, Huh J, Kang IS, Yang JH, Jun TG. How Long Can the Next Intervention Be Delayed after Balloon Dilatation of Homograft in the Pulmonary Position? Korean Circ J 2017; 47:786-793. [PMID: 28955397 PMCID: PMC5614955 DOI: 10.4070/kcj.2017.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/11/2017] [Accepted: 05/31/2017] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives We investigated the effectiveness of balloon dilatation of homograft conduits in the pulmonary position in delaying surgical replacement. Subjects and Methods We reviewed the medical records of patients who underwent balloon dilatation of their homograft in the pulmonary position from 2001 to 2015. The pressure gradient and ratio of right ventricular pressure were measured before and after the procedure. The primary goal of this study was to evaluate the parameters associated with the interval to next surgical or catheter intervention. Results Twenty-eight balloon dilations were performed in 26 patients. The median ages of patients with homograft insertion and balloon dilatation were 20.3 months and 4.5 years, respectively. The origins of the homografts were the aorta (53.6%), pulmonary artery (32.1%), and femoral vein (14.3%). The median interval after conduit implantation was 26.7 months. The mean ratio of balloon to graft size was 0.87. The pressure gradient through the homograft and the ratio of right ventricle to aorta pressure were significantly improved after balloon dilatation (p<0.001). There were no adverse events during the procedure with the exception of one case of balloon rupture. The median interval to next intervention was 12.9 months. The median interval of freedom from re-intervention was 16.6 months. Cox proportional hazards analysis revealed that the interval of freedom from re-intervention differed only according to origin of the homograft (p=0.032), with the pulmonary artery having the longest interval of freedom from re-intervention (p=0.043). Conclusion Balloon dilatation of homografts in the pulmonary position can be safely performed, and homografts of the pulmonary artery are associated with a longer interval to re-intervention.
Collapse
Affiliation(s)
- Hye-In Jeong
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Choi
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Sung Ho Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Jun Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hyuk Yang
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Gook Jun
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
147
|
Hascoet S, Mauri L, Claude C, Fournier E, Lourtet J, Riou JY, Brenot P, Petit J. Infective Endocarditis Risk After Percutaneous Pulmonary Valve Implantation With the Melody and Sapien Valves. JACC Cardiovasc Interv 2017; 10:510-517. [PMID: 28279319 DOI: 10.1016/j.jcin.2016.12.012] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/11/2016] [Accepted: 12/15/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study compared the risk of infective endocarditis (IE) after percutaneous pulmonary valve implantation (PPVI) with the Sapien and Melody valves. BACKGROUND The incidence of IE after PPVI is estimated at 3% per year with the Melody valve. The Sapien valve is a more recently marketed valve used for PPVI. METHODS We retrospectively included consecutive patients who underwent PPVI at a single center between 2008 and 2016. IE was diagnosed using the modified DUKE criteria. RESULTS PPVI was performed in 79 patients (Melody valve, 40.5%; Sapien valve, 59.5%). Median age was 24.9 years (range 18.1 to 34.6). IE occurred in 8 patients (10.1%) at a median of 1.8 years (minimum: 1.0; maximum: 5.6) after surgery. Causative organisms were methicillin-sensitive Staphylococcus aureus (n = 3), Staphylococcus epidermidis (n = 1), Streptococcus mitis (n = 1), Aerococcus viridans (n = 1), Corynebacterium striatum (n = 1), and Haemophilus influenzae (n = 1). All 8 cases occurred after Melody PPVI (25.0% vs. 0.0%). The incidence of IE was 5.7% (95% confidence interval: 2.9% to 11.4%) per person-year after Melody PPVI. The Kaplan-Meier cumulative incidence of IE with Melody PPVI was 24.0% (95% confidence interval: 12.2% to 43.9%) after 4 years and 30.1% (95% confidence interval: 15.8% to 52.5%) after 6 years, compared with 0.0% with the Sapien PPVI after 4 years (p < 0.04 by log-rank test). There was a trend toward a higher incidence of IE in the first 20 patients with Melody PPVI (who received prophylactic antibiotics during the procedure only) and in patients who had percutaneous interventions, dental care, or noncardiac surgery after PPVI. CONCLUSIONS IE after PPVI may be less common with the Sapien compared with the Melody valve.
Collapse
Affiliation(s)
- Sebastien Hascoet
- Hospital Marie Lannelongue, Congenital Heart Diseases Department, Complex Congenital Heart Diseases M3C Network, Paris-Sud University, Paris-Saclay University, Plessis-Robinson, France.
| | - Lucia Mauri
- Hospital Marie Lannelongue, Congenital Heart Diseases Department, Complex Congenital Heart Diseases M3C Network, Paris-Sud University, Paris-Saclay University, Plessis-Robinson, France
| | - Caroline Claude
- Hospital Marie Lannelongue, Congenital Heart Diseases Department, Complex Congenital Heart Diseases M3C Network, Paris-Sud University, Paris-Saclay University, Plessis-Robinson, France
| | - Emmanuelle Fournier
- Hospital Marie Lannelongue, Congenital Heart Diseases Department, Complex Congenital Heart Diseases M3C Network, Paris-Sud University, Paris-Saclay University, Plessis-Robinson, France
| | - Julie Lourtet
- Hospital Saint-Joseph, Department of Microbiology, Paris, France
| | - Jean-Yves Riou
- Hospital Marie Lannelongue, Imaging and Interventional Radiology Department, Paris-Sud University, Paris-Saclay University, Plessis-Robinson, France
| | - Philippe Brenot
- Hospital Marie Lannelongue, Imaging and Interventional Radiology Department, Paris-Sud University, Paris-Saclay University, Plessis-Robinson, France
| | - Jérôme Petit
- Hospital Marie Lannelongue, Congenital Heart Diseases Department, Complex Congenital Heart Diseases M3C Network, Paris-Sud University, Paris-Saclay University, Plessis-Robinson, France
| |
Collapse
|
148
|
Abstract
PURPOSE OF REVIEW Our review is intended to provide readers with an overview of disease processes involving the pulmonic valve, highlighting recent outcome studies and guideline-based recommendations; with focus on the two most common interventions for treating pulmonic valve disease, balloon pulmonary valvuloplasty and pulmonic valve replacement. RECENT FINDINGS The main long-term sequelae of balloon pulmonary valvuloplasty, the gold standard treatment for pulmonic stenosis, remain pulmonic regurgitation and valvular restenosis. The balloon:annulus ratio is a major contributor to both, with high ratios resulting in greater degrees of regurgitation, and small ratios increasing risk for restenosis. Recent studies suggest that a ratio of approximately 1.2 may provide the most optimal results. Pulmonic valve replacement is currently the procedure of choice for patients with severe pulmonic regurgitation and hemodynamic sequelae or symptoms, yet it remains uncertain how it impacts long-term survival. Transcatheter pulmonic valve replacement is a rapidly evolving field and recent outcome studies suggest short and mid-term results at least equivalent to surgery. The Melody valve® was FDA approved for failing pulmonary surgical conduits in 2010 and for failing bioprosthetic surgical pulmonic valves in 2017 and has been extensively studied, whereas the Sapien XT valve®, offering larger diameters, was approved for failing pulmonary conduits in 2016 and has been less extensively studied. Patients with pulmonic valve disease deserve lifelong surveillance for complications. Transcatheter pulmonic valve replacement is a novel and attractive therapeutic option, but is currently only FDA approved for patients with failing pulmonary conduits or dysfunctional surgical bioprosthetic valves. New advances will undoubtedly increase the utilization of this rapidly expanding technology.
Collapse
|
149
|
Cabalka AK, Hellenbrand WE, Eicken A, Kreutzer J, Gray RG, Bergersen L, Berger F, Armstrong AK, Cheatham JP, Zahn EM, McElhinney DB. Relationships Among Conduit Type, Pre-Stenting, and Outcomes in Patients Undergoing Transcatheter Pulmonary Valve Replacement in the Prospective North American and European Melody Valve Trials. JACC Cardiovasc Interv 2017; 10:1746-1759. [DOI: 10.1016/j.jcin.2017.05.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/30/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
|
150
|
Acute and Midterm Outcomes of Transcatheter Pulmonary Valve Replacement for Treatment of Dysfunctional Left Ventricular Outflow Tract Conduits in Patients With Aortopulmonary Transposition and a Systemic Right Ventricle. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004730. [DOI: 10.1161/circinterventions.116.004730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 07/10/2017] [Indexed: 11/16/2022]
|