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Goldstein BH, McElhinney DB, Gillespie MJ, Aboulhosn JA, Levi DS, Morray BH, Cabalka AK, Love BA, Zampi JD, Balzer DT, Law MA, Schiff MD, Hoskoppal A, Qureshi AM. Early Outcomes From a Multicenter Transcatheter Self-Expanding Pulmonary Valve Replacement Registry. J Am Coll Cardiol 2024; 83:1310-1321. [PMID: 38569760 DOI: 10.1016/j.jacc.2024.02.010] [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: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Transcatheter pulmonary valve replacement (TPVR) with the self-expanding Harmony valve (Medtronic) is an emerging treatment for patients with native or surgically repaired right ventricular outflow tract (RVOT) pulmonary regurgitation (PR). Limited data are available since U.S. Food and Drug Administration approval in 2021. OBJECTIVES In this study, the authors sought to evaluate the safety and short-term effectiveness of self-expanding TPVR in a real-world experience. METHODS This was a multicenter registry study of consecutive patients with native RVOT PR who underwent TPVR through April 30, 2022, at 11 U.S. CENTERS The primary outcome was a composite of hemodynamic dysfunction (PR greater than mild and RVOT mean gradient >30 mm Hg) and RVOT reintervention. RESULTS A total of 243 patients underwent TPVR at a median age of 31 years (Q1-Q3: 19-45 years). Cardiac diagnoses were tetralogy of Fallot (71%), valvular pulmonary stenosis (21%), and other (8%). Acute technical success was achieved in all but 1 case. Procedural serious adverse events occurred in 4% of cases, with no device embolization or death. Hospital length of stay was 1 day in 86% of patients. Ventricular arrhythmia prompting treatment occurred in 19% of cases. At a median follow-up of 13 months (Q1-Q3: 8-19 months), 98% of patients had acceptable hemodynamic function. Estimated freedom from the composite clinical outcome was 99% at 1 year and 96% at 2 years. Freedom from TPVR-related endocarditis was 98% at 1 year. Five patients died from COVID-19 (n = 1), unknown causes (n = 2), and bloodstream infection (n = 2). CONCLUSIONS In this large multicenter real-world experience, short-term clinical and hemodynamic outcomes of self-expanding TPVR therapy were excellent. Ongoing follow-up of this cohort will provide important insights into long-term outcomes.
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Affiliation(s)
- Bryan H Goldstein
- Division of Pediatric Cardiology, University of Pittsburgh School of Medicine and Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Doff B McElhinney
- Departments of Cardiothoracic Surgery and Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
| | - Matthew J Gillespie
- Division of Pediatric Cardiology, University of Pennsylvania School of Medicine and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jamil A Aboulhosn
- Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | - Daniel S Levi
- Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | - Brian H Morray
- Department of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Allison K Cabalka
- Divisions of Pediatric Cardiology and Structural Heart Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Barry A Love
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey D Zampi
- Department of Pediatrics, University of Michigan Congenital Heart Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - David T Balzer
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Mark A Law
- Department of Pediatrics, University of Alabama, Birmingham, Alabama, USA
| | - Mary D Schiff
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Arvind Hoskoppal
- Division of Pediatric Cardiology, University of Pittsburgh School of Medicine and Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Athar M Qureshi
- Section of Cardiology, Texas Children's Hospital, Houston, Texas, USA
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Kagiyama Y, Kenny D, Hijazi ZM. Current status of transcatheter intervention for complex right ventricular outflow tract abnormalities. Glob Cardiol Sci Pract 2024; 2024:e202407. [PMID: 38404661 PMCID: PMC10886730 DOI: 10.21542/gcsp.2024.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/11/2023] [Indexed: 02/27/2024] Open
Abstract
Various transcatheter interventions for the right ventricular outflow tract (RVOT) have been introduced and developed in recent decades. Transcatheter pulmonary valve perforation was first introduced in the 1990s. Radiofrequency wire perforation has been the approach of choice for membranous pulmonary atresia in newborns, with high success rates, although complication rates remain relatively common. Stenting of the RVOT is a novel palliative treatment that may improve hemodynamics in neonatal patients with reduced pulmonary blood flow and RVOT obstruction. Whether this option is superior to other surgical palliative strategies or early primary repair of tetralogy of Fallot remains unclear. Transcatheter pulmonary valve replacement has been one of the biggest innovations in the last two decades. With the success of the Melody and SAPIEN valves, this technique has evolved into the gold standard therapy for RVOT abnormalities with excellent procedural safety and efficacy. Challenges remain in managing the wide heterogeneity of postoperative lesions seen in RVOT, and various technical modifications, such as pre-stenting, valve ring modification, or development of self-expanding systems, have been made. Recent large studies have revealed outcomes comparable to those of surgery, with less morbidity. Further experience and multicenter studies and registries to compare the outcomes of various strategies are necessary, with the ultimate goal of a single-step, minimally invasive approach offering the best longer-term anatomical and physiological results.
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Affiliation(s)
- Yoshiyuki Kagiyama
- Department of Pediatric Cardiology, Children’s Health Ireland at Crumlin, Dublin 12, Republic of Ireland
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Damien Kenny
- Department of Pediatric Cardiology, Children’s Health Ireland at Crumlin, Dublin 12, Republic of Ireland
| | - Ziyad M. Hijazi
- Department of Cardiovascular Diseases, Sidra Medicine, and Weill Cornell Medical College, Doha, Qatar
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El Hajj M, Krajcer Z. A roadmap to arrhythmias after transcatheter pulmonary valve replacement in pediatric patients. Catheter Cardiovasc Interv 2023; 101:388-389. [PMID: 36786489 DOI: 10.1002/ccd.30586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/15/2023]
Abstract
Key Points
In pediatric patients undergoing balloon‐expandable transcatheter pulmonary valve replacement within the native right ventricular outflow tract (RVOT), postprocedural ventricular arrhythmias were common and occurred in 33% of patients.
Patients with postprocedural ventricular arrhythmias had a benign course, and all patients with follow‐up were successfully weaned off antiarrhythmic therapy.
Patients with previous transannular patch repairs in the RVOT had an overall lower ventricular arrhythmia burden.
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Affiliation(s)
- Milad El Hajj
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, The Texas Heart Institute, Houston, Texas, USA
- Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Zvonimir Krajcer
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, The Texas Heart Institute, Houston, Texas, USA
- Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
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Barfuss SB, Samayoa JC, Etheridge SP, Pilcher TA, Asaki SY, Ou Z, Boucek DM, Martin MH, Gray RG, Niu MC. Ventricular arrhythmias following balloon-expandable transcatheter pulmonary valve replacement in the native right ventricular outflow tract. Catheter Cardiovasc Interv 2023; 101:10.1002/ccd.30560. [PMID: 36709486 PMCID: PMC10610035 DOI: 10.1002/ccd.30560] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Ventricular arrhythmia incidence in children and adolescents undergoing transcatheter pulmonary valve replacement (TPVR) within the native right ventricular outflow tract (nRVOT) is unknown. We sought to describe the incidence, severity, and duration of ventricular arrhythmias and identify associated risk factors in this population. METHODS This was a retrospective cohort study of 78 patients <21 years of age who underwent TPVR within the nRVOT. Patients were excluded for pre-existing ventricular arrhythmia or antiarrhythmic use. Study variables included surgical history, valve replacement indication, valve type/size, and ventricular arrhythmia. Univariable logistic regression models were used to evaluate factors associated with ventricular arrhythmias, followed by subset analyses. RESULTS Nonsustained ventricular arrhythmia occurred in 26/78 patients (33.3%). The median age at the procedure was 10.3 years (interquartle range [IQR]: 6.5, 12.8). Compared with other nRVOT types, surgical repair with transannular patch was protective against ventricular arrhythmia incidence: odds ratio (OR): 0.35 (95% confidence interval [CI], 0.13-0.95). Patient weight, valve type/size, number of prestents, and degree of stent extension into the RVOT were not associated with ventricular arrhythmia occurrence. Beta blocker was started in 16/26 (61.5%) patients with ventricular arrhythmia. One additional patient was lost to follow-up. The median beta blocker duration was 46 days (IQR 42, 102). Beta blocker was discontinued in 10 patients by 8-week follow-up and in the remaining four by 9 months. CONCLUSIONS Though common after balloon-expandable TPVR within the nRVOT, ventricular arrhythmias were benign and transient. Antiarrhythmic medications were successfully discontinued in the majority at 6- to 8-week follow-up, and in all patients by 20 months.
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Affiliation(s)
- Spencer B Barfuss
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Juan Carlos Samayoa
- Department of Pediatrics, Division of Cardiology, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Susan P Etheridge
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Thomas A Pilcher
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Sarah Yukiko Asaki
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Zhining Ou
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Dana M Boucek
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Mary Hunt Martin
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Robert G Gray
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Mary C Niu
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
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Taylor A, Yang J, Dubin A, Chubb MH, Motonaga K, Goodyer W, Giacone H, Peng L, Romfh A, McElhinney D, Ceresnak S. Ventricular arrhythmias following transcatheter pulmonary valve replacement with the harmony TPV25 device. Catheter Cardiovasc Interv 2022; 100:766-773. [PMID: 36198126 DOI: 10.1002/ccd.30393] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/12/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Transcatheter pulmonary valve replacement (TPVR) with the Harmony valve (Medtronic, Inc.) was recently approved to treat postoperative native outflow tract pulmonary regurgitation. While the 22 mm Harmony valve Early Feasibility Study demonstrated ventricular tachycardia (VT) in only 5% of patients, little is known about ventricular arrhythmias after TPVR with the larger 25 mm valve (TPV25). METHODS A single center review was performed of patients with TPV25 implant from 2020 to 2021. Demographic, cardiac, procedural, and postimplant cardiac telemetry data were collected and compared between patients who did and did not have peri-implant ventricular arrhythmia. RESULTS Thirty patients underwent TPV25 at a median age of 30 years. On postimplant telemetry, VT events were documented in 12 patients (40%); 11 nonsustained VT (NSVT) (median 3 episodes per patient and 6 beats per episode, maximum 157 episodes) and 1 sustained VT (3%), with Torsades de Pointes secondary to a short coupled premature ventricular contraction (PVC). VT events were associated with annular valve positioning (p < 0.001) and increased postimplant PVC burden (p < 0.0001), but there was no association between VT and other demongraphic, historical, or procedural factors. The frequency of NSVT events fell from 3/h from 0 to 12 h postimplant to 0.5/hr from 12 to 24 h (p < 0.001). CONCLUSION VT occurred commonly (40%) in the first 24 h after TPV25 implant, with self-limited NSVT in 11 of 12 patients and 1 patient with cardiac arrest secondary to Torsades de Pointes. VT only occurred with annular valve positioning. Larger, longer-term studies are needed to determine risk factors for and natural history of post-TPVR VT.
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Affiliation(s)
- Anne Taylor
- Department of Pediatrics, Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Jeffrey Yang
- Department of Pediatrics, Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Anne Dubin
- Department of Pediatrics, Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Mark Henry Chubb
- Department of Pediatrics, Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Kara Motonaga
- Department of Pediatrics, Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Will Goodyer
- Department of Pediatrics, Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Heather Giacone
- Department of Pediatrics, Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Lynn Peng
- Department of Pediatrics, Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Anitra Romfh
- Department of Pediatrics, Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Doff McElhinney
- Department of Pediatrics, Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Scott Ceresnak
- Department of Pediatrics, Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
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Ventricular Arrhythmias and Sudden Death Following Percutaneous Pulmonary Valve Implantation in Pediatric Patients. Pediatr Cardiol 2022; 43:1539-1547. [PMID: 35394148 PMCID: PMC9489556 DOI: 10.1007/s00246-022-02881-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/17/2022] [Indexed: 11/24/2022]
Abstract
Reports have suggested a transient increase in ventricular ectopy early after percutaneous pulmonary valve implantation (PPVI). Little is known about the potential for more serious ventricular arrhythmias (VA) in children who undergo PPVI. We sought to evaluate the incidence of severe VA following PPVI in a pediatric population and to explore potential predictive factors. A retrospective cohort study was conducted of patients who underwent PPVI under 20 years of age in our institution from January 2007 to December 2019. The primary outcome of severe VA was defined as sustained and/or hemodynamically unstable ventricular tachycardia (VT), inducible sustained VT, or sudden death of presumed arrhythmic etiology. A total of 21 patients (mean age 16.2 ± 2.1 years; 66.7% male) underwent PPVI. The majority of patients (N = 15; 71.4%) had tetralogy of Fallot (TOF) or TOF-like physiology, with the most common indication being pulmonary insufficiency (N = 10; 47.6%). During a median follow-up of 29.6 months (IQR 10.9-44.0), severe VA occurred in 3 (14.3%) patients aged 15.6 (IQR 14.7-16.1) a median of 12.3 months (IQR 11.2-22.3) after PPVI. All events occurred in patients with TOF-like physiology following Melody valve implant. In conclusion, severe VA can occur long after PPVI in a pediatric population, particularly in those with TOF-like physiology. Further studies are required to elucidate underlying mechanisms and assess strategies to mitigate risks.
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Martin MH, Meadows J, McElhinney DB, Goldstein BH, Bergersen L, Qureshi AM, Shahanavaz S, Aboulhosn J, Berman D, Peng L, Gillespie M, Armstrong A, Weng C, Minich LL, Gray RG. Safety and Feasibility of Melody Transcatheter Pulmonary Valve Replacement in the Native Right Ventricular Outflow Tract. JACC Cardiovasc Interv 2018; 11:1642-1650. [DOI: 10.1016/j.jcin.2018.05.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/07/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
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