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Pan W, Zhou D, Hijazi ZM, Qureshi SA, Promphan W, Feng Y, Zhang G, Liu X, Pan X, Chen L, Cao Q, Tiong KG, Leong MC, Roymanee S, Prachasilchai P, Choi JY, Tomita H, Le Tan J, Akhtar K, Lam S, So K, Tin DN, Nguyen LH, Huo Y, Wang J, Ge J. 2024 Statement from Asia expert operators on transcatheter pulmonary valve replacement. Catheter Cardiovasc Interv 2024; 103:660-669. [PMID: 38419402 DOI: 10.1002/ccd.30978] [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: 09/14/2023] [Revised: 11/13/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
Transcatheter pulmonary valve replacement (TPVR), also known as percutaneous pulmonary valve implantation, refers to a minimally invasive technique that replaces the pulmonary valve by delivering an artificial pulmonary prosthesis through a catheter into the diseased pulmonary valve under the guidance of X-ray and/or echocardiogram while the heart is still beating not arrested. In recent years, TPVR has achieved remarkable progress in device development, evidence-based medicine proof and clinical experience. To update the knowledge of TPVR in a timely fashion, and according to the latest research and further facilitate the standardized and healthy development of TPVR in Asia, we have updated this consensus statement. After systematical review of the relevant literature with an in-depth analysis of eight main issues, we finally established eight core viewpoints, including indication recommendation, device selection, perioperative evaluation, procedure precautions, and prevention and treatment of complications.
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Affiliation(s)
- Wenzhi Pan
- Zhongshan Hopital, Fudan University, Shanghai, China
| | - Daxin Zhou
- Zhongshan Hopital, Fudan University, Shanghai, China
| | - Ziyad M Hijazi
- Pediatrics & Medicine, Weill Cornell Medicine, Doha, Qatar
| | | | - Worakan Promphan
- Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Yuan Feng
- West China Hospital, Sichuan University, Chengdu, China
| | | | - Xianbao Liu
- Second Hospital of Zhejiang Medical University, Hangzhou, China
| | - Xin Pan
- Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | | | | | | | | | | | - Pimpak Prachasilchai
- Queen Sirikit National Institute of Child Health, Pediatric Cardiac Center, Thailand
| | | | | | - Ju Le Tan
- National Heart Center, Singapore, Singapore
| | - Khurram Akhtar
- Armed Forces Institute of Cardiology National Institute of Heart Diseases, Rawalpindi, Pakistan
| | - Simon Lam
- Queen Marry Hospital, Hong Kong, China
| | - Kent So
- The Chinese University of Hong Kong, Hong Kong, China
| | - Do N Tin
- Children's Hospital, Hanoi, Vietnam
| | | | - Yong Huo
- Peking University First Hospital, Beijing, China
| | - Jian'an Wang
- Second Hospital of Zhejiang Medical University, Hangzhou, China
| | - Junbo Ge
- Zhongshan Hopital, Fudan University, Shanghai, China
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Houeijeh A, Karsenty C, Combes N, Batteux C, Lecerf F, Remy F, Valdeolmillos E, Petit J, Hascoet S. A Modified Technique for Transcatheter Pulmonary Valve Implantation of SAPIEN 3 Valves in Large Right Ventricular Outflow Tract: A Matched Comparison Study. J Clin Med 2023; 12:7656. [PMID: 38137725 PMCID: PMC10743789 DOI: 10.3390/jcm12247656] [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: 10/19/2023] [Revised: 11/23/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Percutaneous pulmonary valve implantation (PPVI) with a SAPIEN 3 valve is effective for treating treat right ventricle outflow (RVOT) dysfunction. A modified technique was developed without prestenting using a protective valve delivery method. We aimed to compare the procedural results of the modified technique group (MTG) to those of patients in a conventional technique group (CTG). METHODS We designed a matched before-after study. All consecutive PPVI with SAPIEN 3 performed in the MTG over 9 months were matched, based on the RVOT type and size, to consecutive procedures performed previously with SAPIEN 3. RESULTS A total of 54 patients were included, equally distributed in the two groups. The sizes of the SAPIEN 3 valves were 23 mm (n = 9), 26 mm (n = 9), 29 mm (n = 36). The two groups were similar regarding demographic data, RVOT type, and pre-procedure hemodynamics. PPVI was performed in a single procedure in all patients of the MTG, whereas six (22.2%) patients of the CTG group underwent prestenting as a first step and valve implantation later (p = 0.02). The procedures were successful in all cases. Stent embolization was reported in two patients (7.4%) in the CTG, which were impacted in pulmonary arteries. In one case (3.7%), in the MTG, an unstable 29 mm SAPIEN 3 valve was stabilized with two stents and additional valve-in-valve implantation. The hemodynamics results were good in all cases, without significant differences between the two groups. The procedures' durations and fluoroscopy times were significantly reduced in the MTG (48.1 versus 82.6 min, p < 0.0001; 15.2 versus 29.8 min, p = 0.0002). During follow-up, neither stent fracture nor valve dysfunction was noticed in either group. CONCLUSION PPVI without prestenting and with a protective delivery method of the SAPIEN 3 valve significantly reduces the procedure's complexity, the duration, and the irradiation while maintaining excellent hemodynamics results in selected cases.
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Affiliation(s)
- Ali Houeijeh
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Pediatric Cardiology Unit, Lille University Hospital, Laboratoire EA4489, Lille II University, 59000 Lille, France
| | - Clément Karsenty
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Cardiologie Pédiatrique et Congénitale, Université de Toulouse, Hôpital des Enfants, CHU de Toulouse, 31300 Toulouse, France
| | - Nicolas Combes
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Clinique Pasteur, 31300 Toulouse, France
| | - Clément Batteux
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Inserm UMRS999, Université Paris Saclay, 92350 Le Plessis-Robinson, France
| | - Florence Lecerf
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Inserm UMRS999, Université Paris Saclay, 92350 Le Plessis-Robinson, France
| | - Frederic Remy
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
| | - Estibaliz Valdeolmillos
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Inserm UMRS999, Université Paris Saclay, 92350 Le Plessis-Robinson, France
| | - Jérôme Petit
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
| | - Sébastien Hascoet
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes M3C, Faculté de Médecine, Université Paris Saclay, BME Lab, 92350 Le Plessis-Robinson, France; (C.K.); (N.C.); (C.B.); (F.L.); (F.R.); (E.V.); (J.P.); (S.H.)
- Inserm UMRS999, Université Paris Saclay, 92350 Le Plessis-Robinson, France
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Machanahalli Balakrishna A, Dilsaver DB, Aboeata A, Gowda RM, Goldsweig AM, Vallabhajosyula S, Anderson JH, Simard T, Jhand A. Infective Endocarditis Risk with Melody versus Sapien Valves Following Transcatheter Pulmonary Valve Implantation: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Clin Med 2023; 12:4886. [PMID: 37568289 PMCID: PMC10419461 DOI: 10.3390/jcm12154886] [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: 04/20/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Transcatheter pulmonary valve implantation (TPVI) is an effective non-surgical treatment method for patients with right ventricle outflow tract dysfunction. The Medtronic Melody and the Edwards Sapien are the two valves approved for use in TPVI. Since TPVI patients are typically younger, even a modest annual incidence of infective endocarditis (IE) is significant. Several previous studies have shown a growing risk of IE after TPVI. There is uncertainty regarding the overall incidence of IE and differences in the risk of IE between the valves. METHODS A systematic search was conducted in the MEDLINE, EMBASE, PubMed, and Cochrane databases from inception to 1 January 2023 using the search terms 'pulmonary valve implantation', 'TPVI', or 'PPVI'. The primary outcome was the pooled incidence of IE following TPVI in Melody and Sapien valves and the difference in incidence between Sapien and Melody valves. Fixed effect and random effect models were used depending on the valve. Meta-regression with random effects was conducted to test the difference in the incidence of IE between the two valves. RESULTS A total of 22 studies (including 10 Melody valve studies, 8 Sapien valve studies, and 4 studies that included both valves (572 patients that used the Sapien valve and 1395 patients that used the Melody valve)) were used for the final analysis. Zero IE incidence following TPVI was reported by eight studies (66.7%) that utilized Sapien valves compared to two studies (14.3%) that utilized Melody valves. The pooled incidence of IE following TPVI with Sapien valves was 2.1% (95% CI: 0.9% to 5.13%) compared to 8.5% (95% CI: 4.8% to 15.2%) following TPVI with Melody valves. Results of meta-regression indicated that the Sapien valve had a 79.6% (95% CI: 24.2% to 94.4%, p = 0.019; R2 = 34.4) lower risk of IE incidence compared to the Melody valve. CONCLUSIONS The risk of IE following TPVI differs significantly. A prudent valve choice in favor of Sapien valves to lower the risk of post-TPVI endocarditis may be beneficial.
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Affiliation(s)
| | - Danielle B. Dilsaver
- Department of Medicine, Division of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, NE 68124, USA
| | - Ahmed Aboeata
- Division of Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, NE 68124, USA
| | - Ramesh M. Gowda
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10029, USA
| | - Andrew M. Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA 01199, USA
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE 68105, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Jason H. Anderson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Aravdeep Jhand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Heys R, Walker-Smith T, Evans R, Caputo M, Culliford L, Reeves B, Rogers C, Turner M, Hamilton M, Sheehan K, Viola N, Stoica S, Wright K, Angelini G, Parry A. Off-pump injectable versus on-pump conventional tissue valves for pulmonary valve replacement: the injectable valve implantation randomised trial (INVITE). BMJ Open 2023; 13:e065192. [PMID: 37263697 PMCID: PMC10254783 DOI: 10.1136/bmjopen-2022-065192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 05/04/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES To assess the effectiveness of injectable tissue pulmonary valve compared with standard pulmonary valve in patients requiring pulmonary valve replacement surgery. DESIGN A multicentre, single-blind, parallel two-group randomised controlled trial. Participants were blind to their allocation. Follow-up continued for 6 months. Randomised allocations were generated by a computer using block randomisation, stratified by centre. SETTING Two National Health Service secondary care centres in the UK. PARTICIPANTS People aged 12-80 years requiring pulmonary valve replacement. INTERVENTIONS Participants were randomly allocated (1:1 ratio) to injectable pulmonary valve replacement (IPVR) without cardiopulmonary bypass (CPB) or standard pulmonary valve replacement (SPVR) with CPB. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was chest drainage volume over the first 24 hours after surgery. Secondary outcomes included in-hospital clinical outcomes; valve and heart function 6 months postsurgery and health-related quality of life 6 weeks and 6 months postsurgery. RESULTS Nineteen participants agreed to take part. Eleven were allocated to IPVR and eight to SPVR. The trial was stopped before the target sample size of 60 participants was reached due to challenges in recruitment. The primary analysis includes all randomised participants; there were no withdrawals. Chest drain volume 24 hours after surgery was on average 277.6 mL lower with IPVR (IPVR mean 340.0 mL; SPVR mean 633.8 mL; mean difference, -277.6; 95% CI, -484.0 to -71.2; p=0.005). There were no statistically significant differences in time to readiness for extubation (p=0.476), time to fitness for discharge (p=0.577) and time to first discharge from the intensive care unit (p=0.209). Six participants with IPVR required CPB. Safety profiles and quality of life scores were similar. CONCLUSIONS IPVR reduced chest drain volume despite >50% of participants requiring CPB. There was no evidence of any other benefit of IPVR. TRIAL REGISTRATION NUMBER ISRCTN23538073.
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Affiliation(s)
- Rachael Heys
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Terrie Walker-Smith
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca Evans
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Lucy Culliford
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Barnaby Reeves
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Rogers
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mark Turner
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Mark Hamilton
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Karen Sheehan
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston Foundation NHS Trust, Bristol, UK
| | - Nicola Viola
- Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Serban Stoica
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Kim Wright
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Andrew Parry
- Bristol Heart Institute, University of Bristol, Bristol, UK
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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Gartenberg AJ, Gillespie MJ, Glatz AC. Transcatheter Approaches to Pulmonary Valve Replacement in Congenital Heart Disease: Revolutionizing the Management of RVOT Dysfunction? Semin Thorac Cardiovasc Surg 2022; 35:333-338. [DOI: 10.1053/j.semtcvs.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/11/2022]
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Parekh DR, Qureshi AM. Transcatheter pulmonary valve in failed bioprosthesis. Ann Cardiothorac Surg 2021; 10:720-722. [PMID: 34733707 DOI: 10.21037/acs-2021-tviv-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Dhaval R Parekh
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Houston, TX, USA.,Texas Heart Institute, Houston, TX, USA
| | - Athar M Qureshi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Houston, TX, USA
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Evaluation and Management of Pulmonic Valve Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00897-3] [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: 10/21/2022]
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9
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Shahanavaz S, Zahn EM, Levi DS, Aboulhousn JA, Hascoet S, Qureshi AM, Porras D, Morgan GJ, Bauser Heaton H, Martin MH, Keeshan B, Asnes JD, Kenny D, Ringewald JM, Zablah JE, Ivy M, Morray BH, Torres AJ, Berman DP, Gillespie MJ, Chaszczewski K, Zampi JD, Walsh KP, Julien P, Goldstein BH, Sathanandam SK, Karsenty C, Balzer DT, McElhinney DB. Transcatheter Pulmonary Valve Replacement With the Sapien Prosthesis. J Am Coll Cardiol 2021; 76:2847-2858. [PMID: 33303074 DOI: 10.1016/j.jacc.2020.10.041] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are limited published data focused on outcomes of transcatheter pulmonary valve replacement (TPVR) with either a Sapien XT or Sapien 3 (S3) valve. OBJECTIVES This study sought to report short-term outcomes in a large cohort of patients who underwent TPVR with either a Sapien XT or S3 valve. METHODS Data were entered retrospectively into a multicenter registry for patients who underwent attempted TPVR with a Sapien XT or S3 valve. Patient-related, procedural, and short-term outcomes data were characterized overall and according to type of right ventricular outflow tract (RVOT) anatomy. RESULTS Twenty-three centers enrolled a total of 774 patients: 397 (51%) with a native/patched RVOT; 183 (24%) with a conduit; and 194 (25%) with a bioprosthetic valve. The S3 was used in 78% of patients, and the XT was used in 22%, with most patients receiving a 29-mm (39%) or 26-mm (34%) valve. The implant was technically successful in 754 (97.4%) patients. Serious adverse events were reported in 67 patients (10%), with no difference between RVOT anatomy groups. Fourteen patients underwent urgent surgery. Nine patients had a second valve implanted. Among patients with available data, tricuspid valve injury was documented in 11 (1.7%), and 9 others (1.3%) had new moderate or severe regurgitation 2 grades higher than pre-implantation, for 20 (3.0%) total patients with tricuspid valve complications. Valve function at discharge was excellent in most patients, but 58 (8.5%) had moderate or greater pulmonary regurgitation or maximum Doppler gradients >40 mm Hg. During limited follow-up (n = 349; median: 12 months), 9 patients were diagnosed with endocarditis, and 17 additional patients underwent surgical valve replacement or valve-in-valve TPVR. CONCLUSIONS Acute outcomes after TPVR with balloon-expandable valves were generally excellent in all types of RVOT. Additional data and longer follow-up will be necessary to gain insight into these issues.
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Affiliation(s)
- Shabana Shahanavaz
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - Evan M Zahn
- Guerin Family Congenital Heart Program, The Heart Institute and Department of Pediatrics Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Daniel S Levi
- Department of Pediatrics, Division of Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California, USA
| | - Jamil A Aboulhousn
- Department of Medicine, Ahmanson Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Diego Porras
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gareth J Morgan
- The Heart Institute, Children's Hospital of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
| | - Holly Bauser Heaton
- Division of Cardiology Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mary Hunt Martin
- Division of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, Utah, USA
| | | | | | - Damien Kenny
- Our Lady's Children's Hospital and Mater Hospital, Dublin, Ireland
| | | | - Jenny E Zablah
- The Heart Institute, Children's Hospital of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
| | - Margaret Ivy
- The Heart Institute, Children's Hospital of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
| | - Brian H Morray
- Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alejandro J Torres
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Darren P Berman
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Matthew J Gillespie
- University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kasey Chaszczewski
- University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey D Zampi
- Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Kevin P Walsh
- Our Lady's Children's Hospital and Mater Hospital, Dublin, Ireland
| | - Plessis Julien
- Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Service de Cardiologie, Nantes, France
| | - Bryan H Goldstein
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | - David T Balzer
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Doff B McElhinney
- Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
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Kim MS, Lee W, Kim KB, Lim HG, Kim YJ. A preclinical trial of perventricular pulmonary valve implantation: Pericardial versus aortic porcine valves mounted on self-expandable stent. Artif Organs 2020; 45:E89-E100. [PMID: 33090503 DOI: 10.1111/aor.13845] [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: 05/17/2020] [Revised: 09/03/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022]
Abstract
Perventricular pulmonary valve implantation (PPVI) of a xenograft valve can be a less invasive technique that avoids cardiopulmonary bypass in patients who require pulmonary valve replacement. We compared the hemodynamics, durability, and histologic changes between two different xenogenic valves (pericardial vs. aortic valve porcine xenografts) implanted into the pulmonary valve position using a PPVI technique and evaluated the safety and efficacy of PPVI as a preclinical study. In 18 sheep, pericardial (group porcine pericardial [PP], n = 9) or aortic valve (group porcine aortic valve [PAV], n = 9) xenogenic porcine valves manufactured as a stented valve were implanted using a PPVI technique. The porcine tissues were decellularized, alpha-galactosidase treated, fixed with glutaraldehyde after space-filler treatment, and detoxified to improve durability. Hemodynamic and immunohistochemical studies were performed after the implantation; radiologic and histologic studies were performed after a terminal procedure. All stented valves were positioned properly after the implantation, and echocardiography and cardiac catheterization demonstrated good hemodynamic state and function of the valves. All the anti-α-Gal IgM and IgG titers were below 0.3 optical density. Computed tomography of extracted valves demonstrated no significant differences in the degree of calcification between the two groups (P = .927). Microscopic findings revealed a minimal amount of calcification and no significant infiltration of macrophage or T-cell in both groups, regardless of the implantation duration. The PPVI is a feasible technique. Both stented valves made of PP and PAV showed no significant differences in hemodynamic profile, midterm durability, and degree of degenerative dystrophic calcification.
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Affiliation(s)
- Min-Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Severance Hospital, Seoul, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ki-Bum Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Hong-Gook Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Yong Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
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11
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Kenny D, Rhodes JF, Fleming GA, Kar S, Zahn EM, Vincent J, Shirali GS, Gorelick J, Fogel MA, Fahey JT, Kim DW, Babaliaros VC, Armstrong AK, Hijazi ZM. 3-Year Outcomes of the Edwards SAPIEN Transcatheter Heart Valve for Conduit Failure in the Pulmonary Position From the COMPASSION Multicenter Clinical Trial. JACC Cardiovasc Interv 2019; 11:1920-1929. [PMID: 30286853 DOI: 10.1016/j.jcin.2018.06.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study provides the 3-year follow-up results of the COMPASSION (Congenital Multicenter Trial of Pulmonic Valve Regurgitation Studying the SAPIEN Transcatheter Heart Valve) trial. Patients with moderate to severe pulmonary regurgitation and/or right ventricular outflow tract conduit obstruction were implanted with the SAPIEN transcatheter heart valve (THV). BACKGROUND Early safety and efficacy of the Edwards SAPIEN THV in the pulmonary position have been established through a multicenter clinical trial. METHODS Eligible patients were included if body weight was >35 kg and in situ conduit diameter was ≥16 and ≤24 mm. Adverse events were adjudicated by an independent clinical events committee. Three-year clinical and echocardiographic outcomes were evaluated in these patients. RESULTS Fifty-seven of the 63 eligible patients were accounted for at the 3-year follow-up visit from a total of 69 implantations in 81 enrolled patients. THV implantation was indicated for pulmonary stenosis (7.6%), regurgitation (12.7%), or both (79.7%). Twenty-two patients (27.8%) underwent implantation of 26-mm valves, and 47 patients received 23-mm valves. Functional improvement in New York Heart Association functional class was observed in 93.5% of patients. Mean peak conduit gradient decreased from 37.5 ± 25.4 to 17.8 ± 12.4 mm Hg (p < 0.001), and mean right ventricular systolic pressure decreased from 59.6 ± 17.7 to 42.9 ± 13.4 mm Hg (p < 0.001). Pulmonary regurgitation was mild or less in 91.1% of patients. Freedom from all-cause mortality at 3 years was 98.4%. Freedom from reintervention was 93.7% and from endocarditis was 97.1% at 3 years. There were no observed stent fractures. CONCLUSIONS Transcatheter pulmonary valve replacement using the Edwards SAPIEN THV demonstrates excellent valve function and clinical outcomes at 3-year follow-up.
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Affiliation(s)
- Damien Kenny
- Our Lady's Children's Hospital, Dublin, Ireland.
| | - John F Rhodes
- Miami Children's Health System, Miami, Florida; Duke University School of Medicine, Durham, North Carolina
| | | | - Saibal Kar
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Evan M Zahn
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Julie Vincent
- Morgan Stanley Children's Hospital, New York, New York
| | | | | | - Mark A Fogel
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Dennis W Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | | | - Ziyad M Hijazi
- Sidra Cardiovascular Center of Excellence, Weill Cornell Medical College, Doha, Qatar
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12
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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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Thalmann R, Merkel EM, Akra B, Bombien R, Kozlik-Feldmann RG, Schmitz C. Evaluation of Hybrid Surgical Access Approaches for Pulmonary Valve Implantation in an Acute Swine Model. Comp Med 2019; 69:299-307. [PMID: 31221242 DOI: 10.30802/aalas-cm-18-000062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Percutaneous implantation of the pulmonary valve through peripheral vascular access can be limited due to poor venous access, low patient weight, hemodynamic or rhythmic instability, and size constraints related to the valve. In such cases, hybrid procedures may provide alternatives. Because the most commonly used median sternotomy is unsuitable for chronic trials in large animals, we evaluated several hybrid approaches for pulmonary valve replacement in a swine model. We tested the feasibility of hybrid pulmonary valve implantation in pigs by using inhouse-generated valves containing bare-metal or nitinol stents. Valves consisted of bovine jugular veins, bovine pericardial valves, or sprayed polyurethane valves. Access was achieved through median sternotomy, lower partial sternotomy, transverse sternotomy, or right lateral thoracotomy. The delivery device was introduced in a transventricular manner. Implantation took place under fluoroscopic and epicardial echocardiographic guidance. We achieved implantation of the stented valve in 12 (92.3%) pigs, of which 5 (41.7%) of the implanted valves were in an optimal position. Paravalvular leakage occurred in 2 trials (16.7%). Lower partial sternotomy provided the best trade-off between feasibility and minimized trauma for long-term animal trials. Here we describe our experience with hybrid pulmonary valve implantation in an acute large-animal (swine) model. We demonstrate the feasibility of the procedure in terms of surgical technique and the perioperative management and preparation of the field for a chronic trial.
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14
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Heys R, Angelini G, Caputo M, Culliford L, Pufulete M, Reeves BC, Rogers CA, Stoica S, Parry A. 'Off pump' self-expanding injectable tissue valves (IPVR) versus 'on pump' conventional tissue valves (PVR) for replacement of the pulmonary valve: trial protocol for a randomised controlled trial (InVITe trial). BMJ Open 2019; 9:e026221. [PMID: 30944136 PMCID: PMC6500208 DOI: 10.1136/bmjopen-2018-026221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Patients with congenital heart disease often need repeated operations throughout life to replace the pulmonary valve. Valve replacement with 'injectable' self-expanding valves (which is performed 'off pump' without the use of cardiopulmonary bypass, CPB) may result in quicker recovery and lower risk of major complications than valve replacement with conventional valves (which is performed 'on pump' with the use of CPB). METHODS AND ANALYSIS We are conducting a multicentre, single-blind randomised controlled trial in patients with congenital heart disease and aged between 12 and 80 years. We will randomise participants in a 1:1 ratio to receive either 'off pump' injectable pulmonary valve replacement or 'on pump' conventional pulmonary valve replacement. The primary outcome will be the difference between the groups with respect to post-surgery blood loss (as measured by chest drain volume) in the first 24 hours. Secondary outcomes will include in-hospital outcomes (intensive care unit stay, inotropic/vasodilator support, chest drain volume in the first 12 hours post-surgery, time of readiness for extubation, blood products used in the first 24 hours post-surgery, time of fitness for discharge, valve and heart function 6 months post-surgery (assessed using cardiovascular magnetic resonance and ECHOCARDIOGRAPHY) and health-related quality of life 6 weeks and 6 months post-surgery. ETHICS AND DISSEMINATION This trial has been approved by the South West Exeter Research Ethics Committee. Findings will be shared with participating hospitals and disseminated to the academic community through peer reviewed publications and presentation at national and international meetings. Patients will be informed of the results through patient organisations and newsletters to participants. TRIAL REGISTRATION NUMBER ISRCTN23538073.
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Affiliation(s)
- Rachael Heys
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Massimo Caputo
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lucy Culliford
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Pufulete
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Barnaby C Reeves
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Serban Stoica
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew Parry
- Bristol Heart Institute, University of Bristol, Bristol, UK
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Hascoet S, Dalla Pozza R, Bentham J, Carere RG, Kanaan M, Ewert P, Biernacka EK, Kretschmar O, Deutsch C, Lecerf F, Lehner A, Kantzis M, Kurucova J, Thoenes M, Bramlage P, Haas NA. Early outcomes of percutaneous pulmonary valve implantation using the Edwards SAPIEN 3 transcatheter heart valve system. EUROINTERVENTION 2019; 14:1378-1385. [DOI: 10.4244/eij-d-18-01035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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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.
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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
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17
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Haas NA, Bach S, Vcasna R, Laser KT, Sandica E, Blanz U, Jakob A, Dietl M, Fischer M, Kanaan M, Lehner A. The risk of bacterial endocarditis after percutaneous and surgical biological pulmonary valve implantation. Int J Cardiol 2018; 268:55-60. [DOI: 10.1016/j.ijcard.2018.04.138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/30/2018] [Indexed: 02/04/2023]
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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.
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19
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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]
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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.
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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
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21
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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
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Abstract
We present two cases of percutaneous Sapien XT valve-in-valve implantation in the tricuspid position: a 20-year-old man with severe congenital pulmonary stenosis and percutaneous valvuloplasty, who required surgical implantation of two protheses, pulmonary and tricuspid, and a 12-year-old boy with CHD and a degenerated tricuspid prosthesis. We implanted three Sapien XT valve-in-valves, two in the tricuspid position and one in the pulmonic position. Sapien XT valve-in-valve implantation in the tricuspid position is feasible and can decrease the number of surgeries in CHD patients.
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23
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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.
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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
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A Good Reminder for Common Sense Approaches. JACC Cardiovasc Interv 2017; 10:518-519. [DOI: 10.1016/j.jcin.2017.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/01/2017] [Accepted: 02/03/2017] [Indexed: 11/24/2022]
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Suntharos P, Prieto LR. Percutaneous Pulmonary Valve Implantation in the Native Right Ventricular Outflow Tract Using a 29-mm Edwards SAPIEN 3 Valve. World J Pediatr Congenit Heart Surg 2016; 8:639-642. [DOI: 10.1177/2150135116655125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Percutaneous pulmonary valve implantation is now an acceptable treatment option. The Edwards SAPIEN valve, intended for transcatheter aortic valve implantation, has been used in patients whose landing zone diameter is >22 to 24 mm which is not suitable for Melody valve. We report a patient in whom we successfully placed the latest generation, Edwards SAPIEN 3 (ES3) in the pulmonary position. However, because of the short covered portion of this valve, there was a significant paravalvular leak through the stent struts requiring implantation of a second ES3 valve.
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Affiliation(s)
- Patcharapong Suntharos
- Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH, USA
| | - Lourdes R. Prieto
- Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH, USA
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Loyalka P, Schechter M, Nascimbene A, Raman AS, Ilieascu CA, Gregoric ID, Kar B. Transcatheter Pulmonary Valve Replacement in a Carcinoid Heart. Tex Heart Inst J 2016; 43:341-4. [PMID: 27547148 DOI: 10.14503/thij-15-5310] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Carcinoid heart disease presents as right-sided heart failure attributable to the dysfunction of the tricuspid and pulmonary valves. Although surgical valve replacement is the mainstay of treatment when patients become symptomatic, it is associated with substantial perioperative mortality rates. We present a case of severe pulmonary valve stenosis secondary to carcinoid heart disease, treated successfully with percutaneous valve replacement. A 67-year-old man with severe pulmonary valve stenosis was referred to our center for pulmonary valve replacement. The patient had a history of metastatic neuroendocrine tumor of the small bowel with carcinoid syndrome, carcinoid heart disease, and tricuspid valve regurgitation previously treated with surgical valve replacement. Because of the patient's severe chronic obstructive pulmonary disease and hostile chest anatomy seen on a computed tomographic scan dating from previous cardiothoracic surgery, we considered off-label percutaneous valve replacement a viable alternative to open-heart surgery. A 29-mm Edwards Sapien XT valve was successfully deployed over the native pulmonary valve. There were no adverse sequelae after the procedure, and the patient was discharged from the hospital the next day. This case report shows that percutaneous valve replacement can be a valid option in carcinoid heart disease patients who are not amenable to surgical valve replacement.
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27
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Spriestersbach H, Prudlo A, Bartosch M, Sanders B, Radtke T, Baaijens FPT, Hoerstrup SP, Berger F, Schmitt B. First percutaneous implantation of a completely tissue-engineered self-expanding pulmonary heart valve prosthesis using a newly developed delivery system: a feasibility study in sheep. Cardiovasc Interv Ther 2016; 32:36-47. [PMID: 27139179 DOI: 10.1007/s12928-016-0396-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/17/2016] [Indexed: 11/25/2022]
Abstract
In a European consortium, a decellularized tissue-engineered heart valve (dTEHV) based on vessel-derived cells, a fast-degrading scaffold and a self-expanding stent has been developed. The aim of this study was to demonstrate that percutaneous delivery is feasible. To implant this valve prosthesis transcutaneously into pulmonary position, a catheter delivery system was designed and custom made. Three sheep underwent transjugular prototype implantation. Intracardiac echocardiography (ICE), angiography and computed tomography (CT) were applied to assess the position, morphology, function and dimensions of the stented dTEHV. One animal was killed 3 h after implantation and two animals were followed up for 12 weeks. Explanted valves were analyzed macroscopically and microscopically. In all animals, the percutaneous implantation of the stented dTEHV was successful. The prototype delivery system worked at first attempt in all animals. In the first implantation a 22 F system was used: the valve was slightly damaged during crimping. Loading was difficult due to valve-catheter mismatch in volume. In the second and third implantation a 26 F system was used: the valves fitted adequately and stayed intact. Following implantation, these two valves showed moderate regurgitation due to insufficient coaptation. During follow-up, regurgitation increased due to shortened leaflets. At explantation, macroscopic and microscopic analysis confirmed the second and third valve to be intact. Histology revealed autologous recellularization of the decellularized valve after 12 weeks in vivo. It was demonstrated that completely in vitro tissue-engineered heart valves are thin and stable enough to be crimped and implanted transvenously into pulmonary position.
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Affiliation(s)
- Hendrik Spriestersbach
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Antonia Prudlo
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marco Bartosch
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bart Sanders
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Torben Radtke
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Frank P T Baaijens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Simon P Hoerstrup
- Division of Surgical Research, University and University Hospital Zürich, Zurich, Switzerland
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Boris Schmitt
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Rockefeller T, Shahanavaz S, Zajarias A, Balzer D. Transcatheter implantation of SAPIEN 3 valve in native right ventricular outflow tract for severe pulmonary regurgitation following tetralogy of fallot repair. Catheter Cardiovasc Interv 2016; 88:E28-33. [DOI: 10.1002/ccd.26480] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/19/2016] [Accepted: 01/29/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Toby Rockefeller
- Department of Pediatrics, Division of Cardiology; Washington University School of Medicine
| | - Shabana Shahanavaz
- Department of Pediatrics, Division of Cardiology; Washington University School of Medicine
| | - Alan Zajarias
- Cardiovascular Division; Washington University School of Medicine
| | - David Balzer
- Department of Pediatrics, Division of Cardiology; Washington University School of Medicine
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29
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Transcatheter valve-in-valve therapy using 6 different devices in 4 anatomic positions: Clinical outcomes and technical considerations. J Thorac Cardiovasc Surg 2015; 150:1557-65, 1567.e1-3; discussion 1565-7. [DOI: 10.1016/j.jtcvs.2015.08.065] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/04/2015] [Accepted: 08/11/2015] [Indexed: 11/18/2022]
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Praz F, Windecker S, Huber C, Carrel T, Wenaweser P. Expanding Indications of Transcatheter Heart Valve Interventions. JACC Cardiovasc Interv 2015; 8:1777-96. [DOI: 10.1016/j.jcin.2015.08.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 01/10/2023]
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31
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Transcatheter Pulmonary Valve Replacement With the Edwards Sapien System. JACC Cardiovasc Interv 2015; 8:1819-27. [DOI: 10.1016/j.jcin.2015.08.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 11/22/2022]
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Holzer RJ, Hijazi ZM. Transcatheter pulmonary valve replacement: State of the art. Catheter Cardiovasc Interv 2015; 87:117-28. [DOI: 10.1002/ccd.26263] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/16/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Ralf J. Holzer
- Cardiac Catheterization and Interventional Therapy; Division Chief Cardiology (Acting); Sidra Cardiovascular Center of Excellence, Sidra Medical and Research Center; Doha Qatar
| | - Ziyad M. Hijazi
- Weill Cornell Medical College; Chief Medical Officer (Acting); Chair; Department of Pediatrics; Director; Sidra Cardiovascular Center of Excellence, Sidra Medical and Research Center; Doha Qatar
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33
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Hijazi ZM, Ruiz CE, Zahn E, Ringel R, Aldea GS, Bacha EA, Bavaria J, Bolman RM, Cameron DE, Dean LS, Feldman T, Fullerton D, Horlick E, Mack MJ, Miller DC, Moon MR, Mukherjee D, Trento A, Tommaso CL. SCAI/AATS/ACC/STS Operator and Institutional Requirements for Transcatheter Valve Repair and Replacement, Part III: Pulmonic Valve. J Am Coll Cardiol 2015; 65:2556-63. [DOI: 10.1016/j.jacc.2015.02.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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34
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Rothman A, Galindo A, Evans WN. Implantation of a 29 mm sapien XT valve in a pediatric patient with an unstented right ventricular outflow tract. Catheter Cardiovasc Interv 2015; 86:1087-91. [DOI: 10.1002/ccd.25968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 03/30/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Abraham Rothman
- Children's Heart Center, Pediatric Cardiology Division; Las Vegas Nevada
- School of Medicine; Department of Pediatrics, Division of Cardiology; University of Nevada; Las Vegas Nevada
| | - Alvaro Galindo
- Children's Heart Center, Pediatric Cardiology Division; Las Vegas Nevada
- School of Medicine; Department of Pediatrics, Division of Cardiology; University of Nevada; Las Vegas Nevada
| | - William N. Evans
- Children's Heart Center, Pediatric Cardiology Division; Las Vegas Nevada
- School of Medicine; Department of Pediatrics, Division of Cardiology; University of Nevada; Las Vegas Nevada
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Wagner R, Daehnert I, Lurz P. Percutaneous pulmonary and tricuspid valve implantations: An update. World J Cardiol 2015; 7:167-177. [PMID: 25914786 PMCID: PMC4404372 DOI: 10.4330/wjc.v7.i4.167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/08/2015] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology. Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status. Although techniques of percutaneous pulmonary valve implantation have been described just a decade ago, two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide. In contrast, percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status. Taking into account that an “interdisciplinary challenging”, heterogeneous population of patients previously treated by corrective, semi-corrective or palliative surgical procedures is growing inexorably, there is a rapidly increasing need of treatment options besides redo-surgery. Therefore, the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures, to update on current devices, to discuss indications and patient selection criteria, to report on clinical results and finally to consider future directions.
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Oeser C, Andreas M, Habertheuer A, Kocher A. Quadruple valve replacement and bypass surgery 23 years after the Ross operation†. Interact Cardiovasc Thorac Surg 2015; 21:132-4. [PMID: 25862093 DOI: 10.1093/icvts/ivv092] [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: 12/08/2014] [Accepted: 03/18/2015] [Indexed: 11/12/2022] Open
Abstract
This report describes a case of simultaneous quadruple valve replacement, coronary artery bypass surgery and reconstruction of one aortic sinus performed in a patient who had undergone the Ross operation 23 years previously.
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Affiliation(s)
- Claudia Oeser
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Habertheuer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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SCAI/AATS/ACC/STS Operator and Institutional Requirements for Transcatheter Valve Repair and Replacement, Part III: Pulmonic Valve. Ann Thorac Surg 2015; 99:1857-64. [PMID: 25817888 DOI: 10.1016/j.athoracsur.2014.12.088] [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: 10/21/2014] [Revised: 10/21/2014] [Accepted: 12/31/2014] [Indexed: 11/19/2022]
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Hijazi ZM, Ruiz CE, Zahn E, Ringel R, Aldea GS, Bacha EA, Bavaria J, Bolman RM, Cameron DE, Dean LS, Feldman T, Fullerton D, Horlick E, Mack MJ, Miller DC, Moon MR, Mukherjee D, Trento A, Tommaso CL. SCAI/AATS/ACC/STS operator and institutional requirements for transcatheter valve repair and replacement, part III: Pulmonic valve. J Thorac Cardiovasc Surg 2015; 149:e71-8. [PMID: 25816957 DOI: 10.1016/j.jtcvs.2015.02.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Ziyad M Hijazi
- Sidra Cardiovascular Center of Excellence, Department of Pediatrics, Sidra Medical & Research Center, Doha, Qatar.
| | - Carlos E Ruiz
- Lenox Hill Heart & Vascular Institute of New York, New York, NY
| | - Evan Zahn
- Guerin Family Congenital Heart Program, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Richard Ringel
- Pediatric Cardiac Catheterization Laboratory, The Johns Hopkins Hospital, Baltimore, Md
| | - Gabriel S Aldea
- Regional Heart Center, University of Washington Medical Center, Seattle, Wash
| | - Emile A Bacha
- Pediatric Cardiac Surgery, New York-Presbyterian/Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, NY
| | - Joseph Bavaria
- Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - R Morton Bolman
- Division of Cardiac Surgery, Harvard Medical School, Boston, Mass
| | - Duke E Cameron
- The Dana and Albert "Cubby" Broccoli Center for Aortic Diseases, The Johns Hopkins Hospital, Baltimore, Md
| | - Larry S Dean
- University of Washington, School of Medicine, Seattle, Washington
| | - Ted Feldman
- Cardiac Catheterization Laboratory, Evanston Hospital, Evanston, Ill
| | - David Fullerton
- Cardiothoracic Surgery, University of Colorado Denver, Aurora, Colo
| | - Eric Horlick
- Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Michael J Mack
- Cardiovascular Council Dallas, Heart Hospital Baylor, Plano, Tex
| | - D Craig Miller
- Department of Cardiovascular Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Mo
| | - Debabrata Mukherjee
- Department of Internal Medicine, Cardiovascular Medicine, Texas Tech University, El Paso, Tex
| | - Alfredo Trento
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Carl L Tommaso
- Cardiac Catheterization Laboratory, Skokie Hospital, North Shore University Health System, Skokie, Ill
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39
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Hijazi ZM, Ruiz CE, Zahn E, Ringel R, Aldea GS, Bacha EA, Bavaria J, Bolman RM, Cameron DE, Dean LS, Feldman T, Fullerton D, Horlick E, Mack MJ, Miller DC, Moon MR, Mukherjee D, Trento A, Tommaso CL. SCAI/AATS/ACC/STS operator and institutional requirements for transcatheter valve repair and replacement, Part III: Pulmonic valve. Catheter Cardiovasc Interv 2015; 86:85-93. [PMID: 25809590 DOI: 10.1002/ccd.25710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 11/10/2022]
Abstract
With the evolution of transcatheter valve replacement, an important opportunity has arisen for cardiologists and surgeons to collaborate in identifying the criteria for performing these procedures. Therefore, The Society for Cardiovascular Angiography and Interventions (SCAI), American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), and The Society of Thoracic Surgeons (STS) have partnered to provide recommendations for institutions to assess their potential for instituting and/or maintaining a transcatheter valve program. This article concerns transcatheter pulmonic valve replacement (tPVR). tPVR procedures are in their infancy with few reports available on which to base an expert consensus statement. Therefore, many of these recommendations are based on expert consensus and the few reports available. As the procedures evolve, technology advances, experience grows, and more data accumulate, there will certainly be a need to update this consensus statement. The writing committee and participating societies believe that the recommendations in this report serve as appropriate requisites. In some ways, these recommendations apply to institutions more than to individuals. There is a strong consensus that these new valve therapies are best performed using a Heart Team approach; thus, these credentialing criteria should be applied at the institutional level. Partnering societies used the ACC's policy on relationships with industry (RWI) and other entities to author this document (http://www.acc.org/guidelines/about-guidelines-and-clinical-documents). To avoid actual, potential, or perceived conflicts of interest due to industry relationships or personal interests, all members of the writing committee, as well as peer reviewers of the document, were asked to disclose all current healthcare-related relationships including those existing 12 months before the initiation of the writing effort. A committee of interventional cardiologists and surgeons was formed to include a majority of members with no relevant RWI and to be led by an interventional cardiology cochair and a surgical cochair with no relevant RWI. Authors with relevant RWI were not permitted to draft or vote on text or recommendations pertaining to their RWI. RWI were reviewed on all conference calls and updated as changes occurred. Author and peer reviewer RWI pertinent to this document are disclosed in the Appendices. In addition, to ensure complete transparency, authors' comprehensive disclosure information (including RWI not pertinent to this document) is available in Appendix AII. The work of the writing committee was supported exclusively by the partnering societies without commercial support. SCAI, AATS, ACC, and STS believe that adherence to these recommendations will maximize the chances that these therapies will become a successful part of the armamentarium for treating valvular heart disease in the United States. In addition, these recommendations will hopefully facilitate optimum quality during the delivery of this therapy, which will be important to the development and successful implementation of future, less invasive approaches to structural heart disease.
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Affiliation(s)
- Ziyad M Hijazi
- Sidra Cardiovascular Center of Excellence, Department of Pediatrics, Sidra Medical & Research Center, Doha, Qatar
| | - Carlos E Ruiz
- Lenox Hill Heart & Vascular Institute of New York, New York, New York
| | - Evan Zahn
- Guerin Family Congenital Heart Program, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Richard Ringel
- Pediatric Cardiac Catheterization Laboratory, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Gabriel S Aldea
- Regional Heart Center, University of Washington Medical Center, Seattle, Washington
| | - Emile A Bacha
- Pediatric Cardiac Surgery, New York-Presbyterian/Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, New York
| | - Joseph Bavaria
- Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - R Morton Bolman
- Division of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts
| | - Duke E Cameron
- The Dana and Albert "Cubby" Broccoli Center for Aortic Diseases, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Larry S Dean
- University of Washington, School of Medicine, Seattle, Washington
| | - Ted Feldman
- Cardiac Catheterization Laboratory, Evanston Hospital, Evanston, Illinois
| | - David Fullerton
- Cardiothoracic Surgery, University of Colorado Denver, Aurora, Colorado
| | - Eric Horlick
- Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Michael J Mack
- Cardiovascular Council Dallas, Heart Hospital Baylor, Plano, Texas
| | - D Craig Miller
- Department of Cardiovascular Surgery, Stanford University School of Medicine, Stanford, California
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Debabrata Mukherjee
- Department of Internal Medicine, Cardiovascular Medicine, Texas Tech University, El Paso, Texas
| | - Alfredo Trento
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Carl L Tommaso
- Cardiac Catheterization Laboratory, Skokie Hospital, North Shore University Health System, Skokie, Illinois
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Leventhal A, Shah A, Osten M, Benson L, Horlick E. Transcatheter valve-in-valve therapy: What does the pediatric cardiologist need to know? PROGRESS IN PEDIATRIC CARDIOLOGY 2014. [DOI: 10.1016/j.ppedcard.2014.12.010] [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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Hascoët S, Acar P, Boudjemline Y. Transcatheter pulmonary valvulation: Current indications and available devices. Arch Cardiovasc Dis 2014; 107:625-34. [DOI: 10.1016/j.acvd.2014.07.048] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/12/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
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Hascoët S, Baruteau A, Jalal Z, Mauri L, Acar P, Elbaz M, Boudjemline Y, Fraisse A. Stents in paediatric and adult congenital interventional cardiac catheterization. Arch Cardiovasc Dis 2014; 107:462-75. [PMID: 25128078 DOI: 10.1016/j.acvd.2014.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 11/15/2022]
Abstract
A 'stent' is a tubular meshed endoprosthesis that has contributed to the development of interventional catheterization over the past 30 years. In congenital heart diseases, stents have offered new solutions to the treatment of congenital vessel stenosis or postsurgical lesions, to maintain or close shunt patency, and to allow transcatheter valve replacement. First, stents were made of bare metal. Then, stent frameworks evolved to achieve a better compromise between radial strength and flexibility. However, almost all stents used currently in children have not been approved for vascular lesions in children and are therefore used 'off-label'. Furthermore, the inability of stents to follow natural vessel growth still limits their use in low-weight children and infants. Recently, bioresorbable stents have been manufactured and may overcome this issue; they are made from materials that may dissolve or be absorbed in the body. In this review, we aim to describe the history of stent development, the technical characteristics of stents used currently, the clinical applications and results, and the latest technological developments and perspectives in paediatric and adult congenital cardiac catheterization.
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Affiliation(s)
- Sebastien Hascoët
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C CHU Toulouse, Paediatric and Congenital Cardiology, Children's Hospital, Paul-Sabatier University, 31059 Toulouse, France; Inserm UMR 1048, Équipe 8, I2MC, institut des maladies métaboliques et cardiovasculaires, Paul-Sabatier University, 31432 Toulouse, France; CHU Toulouse, Department of Cardiology, Rangueil Hospital, Paul-Sabatier University, 31400 Toulouse, France.
| | - Alban Baruteau
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery, Paris Sud University, 92350 Paris, France; Inserm UMR 1087, CNRS UMR6291, institut du thorax, Nantes University, 70721 Nantes, France
| | - Zakaria Jalal
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C CHU Bordeaux, Paediatric and Congenital Cardiology, Haut l'Évêque Hospital, 33600 Bordeaux, France
| | - Lucia Mauri
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C CHU Marseille, Paediatric and Congenital Cardiology, La Timone Hospital, 13385 Marseille, France
| | - Philippe Acar
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C CHU Toulouse, Paediatric and Congenital Cardiology, Children's Hospital, Paul-Sabatier University, 31059 Toulouse, France
| | - Meyer Elbaz
- CHU Toulouse, Department of Cardiology, Rangueil Hospital, Paul-Sabatier University, 31400 Toulouse, France
| | - Younes Boudjemline
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C Necker Hospital for Sick Children, Paediatric Cardiology, Paris 5 René Descartes University, 75015 Paris, France; M3C Georges Pompidou European Hospital, Adult Congenital Cardiology, 75015 Paris, France
| | - Alain Fraisse
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C CHU Marseille, Paediatric and Congenital Cardiology, La Timone Hospital, 13385 Marseille, France
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Abstract
PURPOSE OF REVIEW Catheter-based valve technologies have evolved rapidly over the last decade. Transcatheter aortic valve replacement (TAVR) has become a routine procedure in high-risk adult patients with calcific aortic stenosis. In patients with congenital heart disease (CHD), transcatheter pulmonary valve replacement represents a transformative technology for right ventricular outflow tract dysfunction with the potential to expand to other indications. This review aims to summarize the current state-of-the-art for transcatheter valve replacement (TVR) in CHD; the expanding indications for TVR; and the technological obstacles to optimizing TVR. RECENT FINDINGS Multiple case series have demonstrated that TVR with the Melody transcatheter pulmonary valve in properly selected patients is safe, effective, and durable in short-term follow-up. The Sapien transcatheter heart valve represents an alternative device with similar safety and efficacy in limited studies. Innovative use of current valves has demonstrated the flexibility of TVR, while highlighting the need for devices to address the broad range of postoperative anatomies either with a single device or with strategies to prepare the outflow tract for subsequent device deployment. SUMMARY The potential of TVR has not been fully realized, but holds promise in treatment of CHD.
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Bauner K, Kozlik-Feldmann R. [Minimally invasive pulmonary valve replacement in pediatric patients: importance of imaging]. Radiologe 2014; 53:880-5. [PMID: 24036905 DOI: 10.1007/s00117-012-2471-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CLINICAL/METHODICAL ISSUE Right ventricular outflow tract (RVOT) dysfunction with pulmonary regurgitation or obstruction is a common postsurgical consequence in congenital heart disease. STANDARD RADIOLOGICAL METHODS Magnetic resonance imaging (MRI) is widely accepted as standard method of imaging in congenital heart disease. It provides anatomical and functional information without radiation exposure and is therefore well suited for serial examinations. METHODICAL INNOVATIONS Percutaneous pulmonary valve implantation (PPVI) has been shown to be a safe and effective treatment option for patients with pulmonary valve insufficiency or stenosis. Correct patient selection for PPVI is crucial. It is important to be familiar with the indications and anatomical requirements for stent placement and to tailor imaging protocols. PERFORMANCE Imaging the RVOT, assessment of right ventricular volumes and function and calculation of pulmonary flow and regurgitation are core elements of the MRI examination prior to PPVI. Low interobserver and intraobserver variation allows even small changes to be detected. ACHIEVEMENTS Imaging provides relevant information for correct patient selection for PPVI and is part of postinterventional follow-up. Imaging is an important tool for documentation of success and for detection of complications. PRACTICAL RECOMMENDATIONS Several imaging modalities are used for evaluation of RVOTs; however, MRI can provide answers to most questions without radiation exposure.
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Affiliation(s)
- K Bauner
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland,
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Valve-in-valve implantations: is this the new standard for degenerated bioprostheses? Review of the literature. Clin Res Cardiol 2014; 103:417-29. [PMID: 24445751 DOI: 10.1007/s00392-013-0653-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/09/2013] [Indexed: 02/05/2023]
Abstract
Transcatheter aortic valve implantation has established itself as an alternative treatment for patients with valvular disease. In the current context of increasing bioprosthetic valve implants and an ageing population with growing comorbidities, a less invasive approach to the treatment of bioprosthetic dysfunction would be an appealing alternative to the standard of care. Transcatheter valve-in-valve implantation could be an alternative for patients who are deemed to be a high surgical risk. The valve-in-valve procedure is a minimally invasive percutaneous procedure where a valve can be implanted directly within a failing bioprosthetic valve. This technique can be applied to dysfunctional aortic bioprosthetic valves and can also be used in the pulmonary and atrioventricular valve bioprosthesis. We review the current literature to assess whether this technique may be the new standard for degenerated bioposthesis.
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MacDonald ST, Carminati M, Chessa M. Managing adults with congenital heart disease in the catheterization laboratory: state of the art. Expert Rev Cardiovasc Ther 2014; 8:1741-52. [DOI: 10.1586/erc.10.165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kefer J, Sluysmans T, Vanoverschelde JL. Transcatheter Sapien valve implantation in a native tricuspid valve after failed surgical repair. Catheter Cardiovasc Interv 2013; 83:841-5. [PMID: 24339249 DOI: 10.1002/ccd.25330] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/23/2013] [Accepted: 11/28/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We describe the first report of a transcatheter Sapien implantation in a native tricuspid valve after multiple failed surgical repairs with a lack of prosthetic material and radiographic landmarks. METHODS AND RESULTS A 47-year old female underwent multiple valve repairs and replacements including three tricuspid valve repairs without surgical ring or bioprosthesis implantation. She developed signs of right heart failure associated with a mixed tricuspid disease combining a severe stenosis and regurgitation. After surgical turn down, a revalvulation using a transcatheter approach was attempted. The challenges in this case were the absence of a stiff region to anchor the percutaneous valve, the lack of radiographic landmarks and the difficulties of precise annulus measurements. The applied strategy was -under general anesthesia and extracorporeal membrane oxygenation-: balloon sizing, prestenting of the tricuspid annulus using covered stents followed by Sapien valve implantation through the femoral vein under fluoroscopy and transoesophageal echocardiography (TEE). The procedure was successfull, solving the tricuspid leak and stenosis (peak gradient from 22 to 3 mm Hg) using two Sapien for a perfect positioning. It was complicated by pulmonary bleeding due to a distal wire exit, treated successfully by coil embolization. The clinical and echocardiographic outcome was good up to 5 months. CONCLUSIONS Transcatheter Sapien valve implantation in a native tricuspid valve after failed multiple surgical repairs is feasible by the femoral vein. Technical challenges due to the lack of rigid landing zone and fluoroscopic markers were solved by prestenting and valve implantation under bi-plane fluoroscopic and TEE guidance.
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Affiliation(s)
- Joelle Kefer
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Division of Cardiology, Avenue Hippocrate 10-2881, Brussels, 1200, Belgium
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Mylotte D, Martucci G, Piazza N, McElhinney D. Percutaneous options for heart failure in adults with congenital heart disease. Heart Fail Clin 2013; 10:179-96. [PMID: 24275303 DOI: 10.1016/j.hfc.2013.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the context of congenital heart disease (CHD), the complex biochemical and physiologic response to the pressure- or volume-loaded ventricle can be induced by stenotic and shunt/regurgitant lesions, respectively. A range of transcatheter therapies have recently emerged to expand the therapeutic potential of the more traditional surgical and medical interventions for heart failure in patients with CHD. Together, these complementary interventions aim to treat the growing patient population with adult CHD (ACHD). In this article, the most commonly used transcatheter interventions for heart failure in patients with ACHD are reviewed.
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Affiliation(s)
- Darren Mylotte
- Department of Interventional Cardiology, McGill University Health Centre, Royal Victoria Hospital, 687, Pine Avenue West, Montréal H3A-1A1, Québec, Canada
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Evolving trends in interventional cardiology: endovascular options for congenital disease in adults. Can J Cardiol 2013; 30:75-86. [PMID: 24365192 DOI: 10.1016/j.cjca.2013.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/06/2013] [Accepted: 11/06/2013] [Indexed: 02/06/2023] Open
Abstract
As increasing numbers of patients with congenital heart disease enter adulthood, there is a growing need for minimally invasive percutaneous interventions, primarily to minimize the number of repeated surgeries required by these patients. The use of percutaneous devices is commonplace for the treatment of simple lesions, such as atrial septal defect, patent foramen ovale, patent duct arteriosus, and abnormal vascular connections. There is also substantial experience with device closure of membranous and muscular ventricular septal defects, as well as more complex shunts such as baffle leaks after atrial switch repair and ventricular pseudoaneurysms. An increasing use of covered stents has improved the safety of aortic coarctation, conduit, and branch pulmonary stenosis interventions. Percutaneous pulmonary valve implantation now has an established role in the setting of dysfunctional right ventricle-pulmonary artery conduits or failing bioprosthetic pulmonary valves. Many patients remain unsuitable for percutaneous pulmonary valve implantation because of large diameter "native" outflow tracts, however, various techniques have emerged and multiple devices are in development to provide solutions for these unique anatomic challenges. Hybrid approaches involving use of surgical and transcatheter techniques are increasingly common, serving to optimize efficacy and safety of certain procedures; they depend on a collaborative and collegial relationship between cardiac surgeons and interventionalists that is primarily patient-centred.
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