|
4
|
Schoonbeek RC, Takebayashi S, Aoki C, Shimaoka T, Harris MA, Fu GL, Kim TS, Dori Y, McGarvey J, Litt H, Bouma W, Zsido G, Glatz AC, Rome JJ, Gorman RC, Gorman JH, Gillespie MJ. Implantation of the Medtronic Harmony Transcatheter Pulmonary Valve Improves Right Ventricular Size and Function in an Ovine Model of Postoperative Chronic Pulmonary Insufficiency. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.003920. [PMID: 27662847 DOI: 10.1161/circinterventions.116.003920] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/26/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary insufficiency is the nexus of late morbidity and mortality after transannular patch repair of tetralogy of Fallot. This study aimed to establish the feasibility of implantation of the novel Medtronic Harmony transcatheter pulmonary valve (hTPV) and to assess its effect on pulmonary insufficiency and ventricular function in an ovine model of chronic postoperative pulmonary insufficiency. METHODS AND RESULTS Thirteen sheep underwent baseline cardiac magnetic resonance imaging, surgical pulmonary valvectomy, and transannular patch repair. One month after transannular patch repair, the hTPV was implanted, followed by serial magnetic resonance imaging and computed tomography imaging at 1, 5, and 8 month(s). hTPV implantation was successful in 11 animals (85%). There were 2 procedural deaths related to ventricular fibrillation. Seven animals survived the entire follow-up protocol, 5 with functioning hTPV devices. Two animals had occlusion of hTPV with aneurysm of main pulmonary artery. A strong decline in pulmonary regurgitant fraction was observed after hTPV implantation (40.5% versus 8.3%; P=0.011). Right ventricular end diastolic volume increased by 49.4% after transannular patch repair (62.3-93.1 mL/m2; P=0.028) but was reversed to baseline values after hTPV implantation (to 65.1 mL/m2 at 8 months, P=0.045). Both right ventricular ejection fraction and left ventricular ejection fraction were preserved after hTPV implantation. CONCLUSIONS hTPV implantation is feasible, significantly reduces pulmonary regurgitant fraction, facilitates right ventricular volume improvements, and preserves biventricular function in an ovine model of chronic pulmonary insufficiency. This percutaneous strategy could potentially offer an alternative for standard surgical pulmonary valve replacement in dilated right ventricular outflow tracts, permitting lower risk, nonsurgical pulmonary valve replacement in previously prohibitive anatomies.
Collapse
Affiliation(s)
- Rosanne C Schoonbeek
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Satoshi Takebayashi
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Chikashi Aoki
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Toru Shimaoka
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Matthew A Harris
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Gregory L Fu
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Timothy S Kim
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Yoav Dori
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Jeremy McGarvey
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Harold Litt
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Wobbe Bouma
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Gerald Zsido
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Andrew C Glatz
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Jonathan J Rome
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Robert C Gorman
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Joseph H Gorman
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.)
| | - Matthew J Gillespie
- From the Gorman Cardiovascular Research Group, Department of Surgery, The Children's Hospital of Philadelphia, PA (R.C.S., S.T., C.A., T.S., J.M., W.B., G.Z., R.C.G., J.H.G., M.J.G.); Department of Cardiology (M.A.H., G.L.F., T.S.K, Y.D., A.C.G, J.J.R., M.J.G.) and Department Radiology (H.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands (R.C.S., W.B.).
| |
Collapse
|