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Matoq A, Shahanavaz S. Transcatheter Pulmonary Valve in Congenital Heart Disease. Interv Cardiol Clin 2024; 13:369-384. [PMID: 38839170 DOI: 10.1016/j.iccl.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Over the last 2 decades, experience with transcatheter pulmonary valve replacement (TPVR) has grown significantly and has become an effective and reliable way of treating pulmonary valve regurgitation, right ventricular outflow (RVOT) obstruction, and dysfunctional bioprosthetic valves and conduits. With the introduction of self-expanding valves and prestents, dilated native RVOT can be addressed with the transcatheter approach. In this article, the authors review the current practices, technical challenges, and outcomes of TPVR.
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Affiliation(s)
- Amr Matoq
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Shabana Shahanavaz
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Lopes V, Almeida PC, Moreira N, Ferreira LA, Teixeira R, Donato P, Gonçalves L. Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03140-9. [PMID: 38780710 DOI: 10.1007/s10554-024-03140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.
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Affiliation(s)
- Vanessa Lopes
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
| | - Pedro Carvalho Almeida
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Nádia Moreira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Luís Amaral Ferreira
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Rogério Teixeira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
| | - Paulo Donato
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Univ Coimbra, Coimbra Institute for Biomedical Imaging and Translation Research (CIBIT), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Univ Coimbra, Coimbra, Portugal
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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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Kelleher ST, Regan IE, Cox D, Shaw K, Franklin O, Kenny DP, Walsh KP, McMahon CJ. Aspirin Responsiveness in a Cohort of Pediatric Patients with Right Ventricle to Pulmonary Artery Conduits and Transcatheter Valve Replacement Systems. Pediatr Cardiol 2024:10.1007/s00246-024-03449-1. [PMID: 38489091 DOI: 10.1007/s00246-024-03449-1] [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: 08/08/2023] [Accepted: 02/10/2024] [Indexed: 03/17/2024]
Abstract
The aim of this study was to determine the rate of aspirin responsiveness in a cohort of pediatric patients with in situ xenograft valved right ventricle to pulmonary artery (RV-PA) conduits and/or transcatheter valve replacements (TVR). Aspirin is routinely prescribed to these patients. Optimizing anti-platelet therapy could promote valve longevity and reduce the risk of infective endocarditis in this at-risk group. This was a prospective, observational study. Patients were recruited from both ward and outpatient settings. Patients were eligible if under 18 years and taking aspirin. Non-response to aspirin was defined as > 20% platelet aggregation using light transmission platelet aggregometry (LTA) and < 50% platelet inhibition by thromboelastography with platelet mapping (TEGPM). Participants were invited to provide a confirmatory sample in cases of aspirin resistance and dose adjustments were made. Thirty patients participated. Median age was 9 years (2 months to 18 years). The majority (93%) had complex right ventricular outflow tract pathology. 13 (43%) had an RV-PA conduit and 24 (80%) had a TVR, with valve situated in conduit in 7 (23%) cases. Rate of aspirin non-response on initial testing was 23% (n = 7/30) with median LTA 74.55% (60-76%) and TEG 13.25% (0-44%) in non-responders. Non-responders were more likely to be under 1 year. Two patients required dose increases and one patient non-adherence to dose was identified. Four patients on repeat testing were responsive to aspirin by laboratory tests. The rate of aspirin non-response on laboratory testing in this cohort of patients was 23% and resulted in therapeutic intervention in 10%.
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Affiliation(s)
- Sean T Kelleher
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Irene E Regan
- Department of Coagulation/Haematology, Children's Health Ireland at Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland
| | - Dermot Cox
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Kathryn Shaw
- Department of Paediatric Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Orla Franklin
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Damien P Kenny
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Kevin P Walsh
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland.
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland.
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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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Maione D, De Luca A, Pezzato A, Vitrella G, Perkan A, Rauber E, Butera G, Sinagra G. Bioprosthetic pulmonary valve dysfunction in a primary cardiac sarcoma survivor: Clinical considerations and treatment options. Clin Case Rep 2024; 12:e8401. [PMID: 38356779 PMCID: PMC10865915 DOI: 10.1002/ccr3.8401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/25/2023] [Accepted: 12/14/2023] [Indexed: 02/16/2024] Open
Abstract
The case highlights the good survival after radical surgery and chemotherapy of a cardiac sarcoma, and the need for close follow-up due to possible early postsurgical complications.
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Affiliation(s)
- Davide Maione
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
- Postgraduate School of Cardiovascular Medicine University of TriesteTriesteItaly
| | - Antonio De Luca
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Andrea Pezzato
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
- Postgraduate School of Cardiovascular Medicine University of TriesteTriesteItaly
| | - Giancarlo Vitrella
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Andrea Perkan
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Elisabetta Rauber
- Cardiothoracovascular Department, Division of Cardiac SurgeryAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Gianfranco Butera
- Division of Interventional CardiologyChildren's Hospital Bambino GesùRomeItaly
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
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Stefanescu Schmidt AC, Armstrong AK, Aboulhosn JA, Kennedy KF, Jones TK, Levi DS, McElhinney DB, Bhatt AB. Transcatheter Pulmonary Valve Replacement With Balloon-Expandable Valves: Utilization and Procedural Outcomes From the IMPACT Registry. JACC Cardiovasc Interv 2024; 17:231-244. [PMID: 38267137 DOI: 10.1016/j.jcin.2023.10.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/03/2023] [Accepted: 10/31/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Transcatheter pulmonary valve replacement (TPVR) has expanded and evolved since its initial commercial approval in the United States in 2010. OBJECTIVES This study sought to characterize real-world practice, including patient selection, procedural outcomes, complications, and off-label usage. METHODS Characteristics and outcomes for patients undergoing balloon-expandable TPVR were collected from the American College of Cardiology National Cardiovascular Data Registry IMPACT (Improving Pediatric and Adult Congenital Treatment) Registry. RESULTS Between April 2016 and March 2021, 4,513 TPVR procedures were performed in patients with a median age of 19 years, 57% with a Melody (Medtronic Inc) and 43% with a SAPIEN (Edwards Lifesciences) valve. Most implanting centers performed <10 cases annually. One-third of transcatheter pulmonary valve implants were into homograft conduits, one-third were into bioprosthetic valves (BPVs), 25% were in native or patched right ventricular outflow tracts (RVOTs), and 6% were into Contegra (Medtronic Inc) conduits. Over the course of the study period, SAPIEN valve use grew from ∼25% to 60%, in large part because of implants in patients with a native/patched RVOT. Acute success was achieved in 95% of patients (95.7% in homografts, 96.2% in BPVs, 94.2% in native RVOTs, and 95.4% in Contegra conduits). Major adverse events occurred in 2.4% of procedures, more commonly in patients with a homograft (2.9%) or native RVOT (3.4%) than a prior BPV (1.4%; P = 0.004). CONCLUSIONS This study describes novel population data on the use and procedural outcomes of TPVR with balloon-expandable valves. Over time, there has been increasing use of TPVR to treat regurgitant native RVOT anatomy, with the SAPIEN valve more commonly used for this application.
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Affiliation(s)
- Ada C Stefanescu Schmidt
- Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | | | - Jamil A Aboulhosn
- Ahmanson/University of California, Los Angeles Adult Congenital Heart Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA
| | | | - Thomas K Jones
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Daniel S Levi
- Mattel Children's Hospital at University of California-Los Angeles, Los Angeles, California, USA
| | | | - Ami B Bhatt
- Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; American College of Cardiology, Washington, DC, USA
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Hascoët S, Bentham JR, Giugno L, Betrián-Blasco P, Kempny A, Houeijeh A, Baho H, Sharma SR, Jones MI, Biernacka EK, Combes N, Georgiev S, Bouvaist H, Martins JD, Kantzis M, Turner M, Schubert S, Jalal Z, Butera G, Malekzadeh-Milani S, Valdeolmillos E, Karsenty C, Ödemiş E, Aldebert P, Haas NA, Khatib I, Wåhlander H, Gaio G, Mendoza A, Arif S, Castaldi B, Dohlen G, Carere RG, Del Cerro-Marin MJ, Kitzmüller E, Hermuzi A, Carminati M, Guérin P, Tengler A, Fraisse A. Outcomes of transcatheter pulmonary SAPIEN 3 valve implantation: an international registry. Eur Heart J 2024; 45:198-210. [PMID: 37874971 DOI: 10.1093/eurheartj/ehad663] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND AND AIMS Transcatheter pulmonary valve implantation (TPVI) is indicated to treat right-ventricular outflow tract (RVOT) dysfunction related to congenital heart disease (CHD). Outcomes of TPVI with the SAPIEN 3 valve that are insufficiently documented were investigated in the EUROPULMS3 registry of SAPIEN 3-TPVI. METHODS Patient-related, procedural, and follow-up outcome data were retrospectively assessed in this observational cohort from 35 centres in 15 countries. RESULTS Data for 840 consecutive patients treated in 2014-2021 at a median age of 29.2 (19.0-41.6) years were obtained. The most common diagnosis was conotruncal defect (70.5%), with a native or patched RVOT in 50.7% of all patients. Valve sizes were 20, 23, 26, and 29 mm in 0.4%, 25.5%, 32.1%, and 42.0% of patients, respectively. Valve implantation was successful in 98.5% [95% confidence interval (CI), 97.4%-99.2%] of patients. Median follow-up was 20.3 (7.1-38.4) months. Eight patients experienced infective endocarditis; 11 required pulmonary valve replacement, with a lower incidence for larger valves (P = .009), and four experienced pulmonary valve thrombosis, including one who died and three who recovered with anticoagulation. Cumulative incidences (95%CI) 1, 3, and 6 years after TPVI were as follows: infective endocarditis, 0.5% (0.0%-1.0%), 0.9% (0.2%-1.6%), and 3.8% (0.0%-8.4%); pulmonary valve replacement, 0.4% (0.0%-0.8%), 1.3% (0.2%-2.4%), and 8.0% (1.2%-14.8%); and pulmonary valve thrombosis, 0.4% (0.0%-0.9%), 0.7% (0.0%-1.3%), and 0.7% (0.0%-1.3%), respectively. CONCLUSIONS Outcomes of SAPIEN 3 TPVI were favourable in patients with CHD, half of whom had native or patched RVOTs.
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Affiliation(s)
- Sebastien Hascoët
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
- Inserm UMR-S 999, Marie Lannelongue hospital, Paris-Saclay university, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
| | - James R Bentham
- Leeds Teaching Hospitals NHS Trust, Yorkshire Heart Centre, Leeds, UK
| | - Luca Giugno
- Department of Paediatric Cardiology and Adults with congenital heart diseases, IRCCS-Policlinico San Donato, Via Morandi, 30, 20097 San Donato, Milan, Italy
| | - Pedro Betrián-Blasco
- Hospital Universitario Vall d'Hebron, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Aleksander Kempny
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
| | - Ali Houeijeh
- Centre Hospitalier Universitaire de Lille, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, 2 Av. Oscar Lambret, 59000 Lille, France
| | - Haysam Baho
- King Faisal Specialist Hospital, Department of Paediatric Cardiology and Adults with congenital heart diseases, Jeddah, Saudi Arabia
| | - Shiv-Raj Sharma
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
| | - Matthew I Jones
- Evelina London Children's Hospital & St Thomas' Hospital, Departement of Paediatric Cardiology and Adults with Congenital Heart Diseases, Westminster Bridge Rd, London SE1 7EH, United Kingdom
| | - Elżbieta Katarzyna Biernacka
- Cardinal Stefan Wyszyński Institute of Cardiology, Department of Congenital Heart Diseases, Alpejska 42, 04-628 Warsaw, Poland
| | - Nicolas Combes
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
- Clinique Pasteur, Department of Cardiology, 31000 Toulouse, France
| | - Stanimir Georgiev
- Department of Congenital Heart Disease and Pediatric Cardiogy, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Hélène Bouvaist
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Jose Diogo Martins
- Paediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central-EPE, Lisbon, Portugal
| | - Marinos Kantzis
- Glenfield Hosp, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Leicester, United Kingdom
| | - Mark Turner
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Stephan Schubert
- Centre for Congenital Heart Defects, Heart and Diabetes Centre Universitario North Rhine Westphalia, Department for Congenital Heart Defects, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
| | - Zakaria Jalal
- Pediatric and congenital heart diseases department, Bordeaux University Hospital, Pessac, France
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, CRCTB INSERM U1045, Bordeaux, France
| | - Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Estibaliz Valdeolmillos
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
- Inserm UMR-S 999, Marie Lannelongue hospital, Paris-Saclay university, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
| | - Clement Karsenty
- CHU Hôpital des enfants, Department of Paediatric Cardiology, Toulouse, France
| | - Ender Ödemiş
- Koç University Hospital, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Davutpaşa Cd, 34010 Istanbul, Turkey
| | - Philippe Aldebert
- CHU Timone, Assistance Publique des Hôpitaux de Marseille, 278 rue Saint-Pierre, 13385 Marseille, France
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilian University of Munich, Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
| | - Ihab Khatib
- Department of Paediatric Cardiology and Congenital Heart Disease in Adults, Rambam Healthcare Campus, Haifa, Israel
- Department of Paediatric Cardiology and Congenital Heart Disease in Adults, Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israël
| | - Håkan Wåhlander
- Paediatric Heart Centre, Queen Silvia Children's Hospital, Sahlgrenska University Hospital and Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gianpiero Gaio
- Paediatric Cardiology, Ospedali dei Colli, Luigi Vanvitelli University of Campania, Str. Vicinale Reggente, 66/82, 80131 Naples, Italy
| | - Alberto Mendoza
- Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Av de Cordoba s/n, 28041 Madrid, Spain
| | - Sayqa Arif
- University Hospital Birmingham NHS Trust, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - Biagio Castaldi
- Paediatric Cardiology Unit, Department of Child and Woman's Health, University of Padua, Via VIII Febbraio, 2, 35122 Padua, Italy
| | - Gaute Dohlen
- University hospital, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Oslo, Norway
| | - Ronald G Carere
- St Paul's Hospital, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, 1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Maria Jesus Del Cerro-Marin
- Department of Paediatric Cardiology and Adults Congenital Heart Disease, H. Ramón y Cajal University Hospital, Madrid, Spain
| | - Erwin Kitzmüller
- Vienna General Hospital (AKH), Vienna Medical University, Vienna, Austria
| | - Antony Hermuzi
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital Newcastle upon Tyne, Newcastle, United Kingdom
| | - Mario Carminati
- Department of Paediatric Cardiology and Adults with congenital heart diseases, IRCCS-Policlinico San Donato, Via Morandi, 30, 20097 San Donato, Milan, Italy
| | - Patrice Guérin
- Centre Hospitalier Universitaire de Nantes, Department of Cardiology, 1 Pl. Alexis-Ricordeau, 44093 Nantes, France
| | - Anja Tengler
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilian University of Munich, Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
| | - Alain Fraisse
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
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9
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Jurow K, Gauvreau K, Maschietto N, Prakash A. Growth of the right ventricular outflow tract in repaired tetralogy of Fallot: A longitudinal CMR study. J Cardiovasc Magn Reson 2024; 26:100002. [PMID: 38211659 DOI: 10.1016/j.jocmr.2023.100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Many patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR) due to significant pulmonary regurgitation (PR). Transcatheter PVR (TPVR) is an equally effective and less invasive alternative to surgical PVR but many native right ventricular outflow tracts (RVOTs) are too large for TPVR at time of referral. Understanding the rate of growth of the RVOT may help optimize timing of referral. This study aims to examine the longitudinal growth of the native RVOT over time in repaired tetralogy of Fallot (TOF). METHODS A retrospective review of serial cardiac MRI cardiovascular magnetic resonance (CMR) data from 121 patients with repaired TOF and a native RVOT (median age at first CMR 14.7 years, average interval between the first and last CMR of 8.1 years) was performed to measure serial changes in RVOT diameter, cross-sectional area, perimeter-derived diameter, and length. RESULTS All parameters of RVOT size continued to grow with increasing age but growth was more rapid in the decade after TOF repair (for minimum systolic diameter, mean increase of 5.7 mm per 10 years up to year 12, subsequently 2.3 mm per 10 years). The RVOT was larger with a transannular patch and in patients without pulmonary stenosis (p < 0.001 for both), but this was not associated with rate of growth. More rapid RVOT enlargement was noted in patients with larger right ventricular end-diastolic volume (RVEDV), higher PR fraction, and greater rates of increases in RVEDV and PR (p < 0.001 for all) CONCLUSIONS: in patients with repaired TOF, using serial CMR data, we found that RVOT size increased progressively at all ages, but the rate was more rapid in the first decade after repair. More rapid RVOT enlargement was noted in patients with a larger RV, more PR, and greater rates of increases in RV size and PR severity. These results may be important in considering timing of referral for transcatheter pulmonary valves, in planning transcatheter and surgical valve replacement, and in designing future valves for the native RVOT.
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Affiliation(s)
- Kelsey Jurow
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, USA
| | - Nicola Maschietto
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, USA
| | - Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, USA.
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10
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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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11
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Wong N, Shorofsky M, Lim DS. Catheter-based Interventions in Tetralogy of Fallot Across the Lifespan. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:339-351. [PMID: 38161670 PMCID: PMC10755836 DOI: 10.1016/j.cjcpc.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/07/2023] [Indexed: 01/03/2024]
Abstract
Surgical treatment of tetralogy of Fallot (TOF) involves surgical relief of right ventricular outflow tract (RVOT) obstruction and closure of ventricular septal defect. However, some patients may require staged palliation before surgical repair. This traditionally was achieved only with surgery but recently evolved to include catheter-based techniques. RVOT dysfunction occurs inevitably after the surgical repair of TOF and, depending on the surgical approach, manifests as either progressive stenosis, regurgitation, or a combination of both. This predisposes the individual to repeated RVOT interventions with the attendant risks of multiple open-heart surgeries. The advent of transcatheter pulmonary valve replacement has reduced the operative burden, and the expansion of transcatheter pulmonary valve replacement device platforms has widened the type and size of RVOT anatomies that can be treated. This review will discuss the transcatheter therapies available throughout the lifespan of the patient with TOF.
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Affiliation(s)
- Ningyan Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Michael Shorofsky
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - D. Scott Lim
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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12
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Voges I, Krupickova S. Transcatheter Pulmonary Valve Replacement Candidacy: Is Cardiovascular Magnetic Resonance Angiography Enough? Am J Cardiol 2023; 207:507-508. [PMID: 37802700 DOI: 10.1016/j.amjcard.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany; German Centre for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Kiel, Germany.
| | - Sylvia Krupickova
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom; Department of Pediatric Cardiology, Royal Brompton Hospital, part of Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
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13
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Boucek DM, Qureshi AM, Aggarwal V, Spigel ZA, Johnson J, Gray RG, Martin MH. Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement. Cardiol Young 2023; 33:2282-2290. [PMID: 36705001 DOI: 10.1017/s104795112200405x] [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] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine the safety and feasibility of over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement. BACKGROUND Transcatheter pulmonary valve placement is an alternative to surgical pulmonary valve replacement. Traditionally, it was thought to be unsafe to expand a conduit to >110% of its original size. METHODS This retrospective cohort study from two centers includes patients with right ventricle to pulmonary artery conduits with attempted transcatheter pulmonary valve placement from 2010 to 2017. Demographic, procedural, echocardiographic and follow-up data, and complications were evaluated in control and overdilation (to >110% original conduit size) groups. RESULTS One hundred and seventy-two patients (51 overdilation and 121 control) had attempted transcatheter pulmonary valve placement (98% successful). The overdilation group was younger (11.2 versus 16.7 years, p < 0.001) with smaller conduits (15 versus 22 mm, p < 0.001); however, the final valve size was not significantly different (19.7 versus 20.2 mm, p = 0.2). Baseline peak echocardiographic gradient was no different (51.8 versus 55.6 mmHg, p = 0.3). Procedural complications were more frequent in overdilation (18%) than control (7%) groups (most successfully addressed during the procedure). One patient from each group required urgent surgical intervention, with no procedural mortality. Follow-up echocardiographic peak gradients were similar (24.1 versus 26 mmHg, p = 0.5). CONCLUSIONS Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement can be performed successfully. Procedural complications are more frequent with conduit overdilation, but there was no difference in the rate of life-threatening complications. There was no difference in valve function at most recent follow-up, and no difference in rate of reintervention. The long-term outcomes of transcatheter pulmonary valve placement with conduit over-expansion requires further study.
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Affiliation(s)
- Dana M Boucek
- Department of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Masonic Children's Hospital, Minneapolis, MN, USA
| | - Zachary A Spigel
- Department of Surgery, Allegheny Health Network Medical Education Consortium, Pittsburgh, PA, USA
| | - Joyce Johnson
- Department of Pediatric Cardiology, John's Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Robert G Gray
- Department of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mary Hunt Martin
- Department of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
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14
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Steinberg ZL, Cabalka AK, Balzer DT, Asnes JD, Morray BH, Gillespie MJ, McElhinney DB. Right ventricular outflow tract obstruction associated with neointimal tissue accumulation and distortion of the Harmony TPV25 stent frame: Potential mechanisms and treatment. Catheter Cardiovasc Interv 2023; 102:1078-1087. [PMID: 37925624 DOI: 10.1002/ccd.30901] [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: 06/29/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND The Harmony TPV25 transcatheter pulmonary valve (Medtronic Inc.) is constructed with a self-expanding stent frame comprising six zigged nitinol wires sewn together and covered with knitted polyester fabric, with flared inflow and outflow ends and a porcine pericardial valve sutured to the central portion of the device. It was approved for treatment of pulmonary regurgitation after prior right ventricular outflow tract repair in 2021. Early outcomes of this procedure have been excellent, but little is known about valve durability or ultimate mechanisms of dysfunction. METHODS We collected data on patients who underwent reintervention for TPV25 dysfunction and described findings related to distortion of the stent frame and tissue accumulation. RESULTS We describe six patients who underwent valve-in-valve implant for TPV25 obstruction (peak catheterization gradient peak 28-73 mmHg) 10-28 months after implant. In all cases, there was tissue accumulation within the inflow and valve-housing segments of the device and deformation of the self-expanding valve frame characterized by variable circumferential narrowing at the junction between the valve housing and the inflow and outflow portions of the device, with additional geometric changes in all segments. All six patients underwent valve-in-valve implant that results in a final peak gradient ≤10 mmHg and no regurgitation. DISCUSSION The occurrence of short-term Harmony TPV25 dysfunction in multiple patients with a similar appearance of frame distortion and tissue accumulation within the inflow and valve housing portions of the device suggests that this may be an important failure mechanism for this valve. Potential causes of the observed findings are discussed. It is possible to treat this mechanism of TPV25 dysfunction with valve-in-valve implant using balloon expandable transcatheter valves.
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Affiliation(s)
- Zachary L Steinberg
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Allison K Cabalka
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Structural Heart Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - David T Balzer
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeremy D Asnes
- Department of Pediatric Cardiology, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Brian H Morray
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew J Gillespie
- Division of Pediatric Cardiology, University of Pennsylvania School of Medicine and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Doff B McElhinney
- Departments of Cardiothoracic Surgery and Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
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15
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Diaz-Castrillon CE, Viegas M, Castro-Medina M, Punu K, Tarun S, DaSilva Da Fonseca L, Morell V. Pulmonary Homograft vs Handmade Polytetrafluoroethylene-Valved Conduits After the Ross Procedure. Ann Thorac Surg 2023; 116:980-986. [PMID: 37429515 DOI: 10.1016/j.athoracsur.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/26/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND This study aimed to longitudinally compare expanded polytetrafluoroethylene (ePTFE)-valved conduits vs pulmonary homograft (PH) conduits after right ventricular outflow tract reconstruction in the Ross procedure. METHODS Patients undergoing a Ross procedure from June 2004 to December 2021 were identified. Echocardiographic data, catheter-based interventions, or conduit replacements, as well as time to first reintervention or replacement, were comparatively assessed between handmade ePTFE-valved conduits and PH conduits. RESULTS A total of 90 patients were identified. The median age and weight were 13.8 years (interquartile range [IQR], 8.08-17.80 years) and 48.3 kg (IQR, 26.8-68.7 kg), respectively. There were 66% (n = 60) ePTFE-valved conduits and 33% (n = 30) PHs. The median size was 22 mm (IQR, 18-24 mm) for ePTFE-valved conduits and 25 mm (IQR, 23-26 mm) for PH conduits (P < .001). Conduit type had no differential effect in the gradient evolution or the odds of presenting with severe regurgitation in the last follow-up echocardiogram. Of the 26 first reinterventions, 81% were catheter-based interventions, without statistically significant differences between the groups (69% PH vs 83% ePTFE). The overall surgical conduit replacement rate was 15% (n = 14), and it was higher in the homograft group (30% vs 8%; P = .008). However, conduit type was not associated with an increased hazard for reintervention or reoperation after adjusting for covariates. CONCLUSIONS Right ventricular outflow tract reconstruction using handmade ePTFE-valved conduits after a Ross procedure provides encouraging midterm results, without a differential effect in hemodynamic performance or valve function compared with PH conduits. These results are reassuring about the use of handmade valved conduits in pediatric and young adult patients. Longer follow-up of tricuspid conduits will complement valve competency assessment.
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Affiliation(s)
- Carlos E Diaz-Castrillon
- Division of Pediatric Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melita Viegas
- Division of Pediatric Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Mario Castro-Medina
- Division of Pediatric Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kristian Punu
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shwetabh Tarun
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Luciana DaSilva Da Fonseca
- Division of Pediatric Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Victor Morell
- Division of Pediatric Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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16
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Sabbak N, Denby K, Kumar A, Goldar G, Ghobrial J. Intravascular Lithotripsy for Severe RVOT Calcification to Optimize Transcatheter Pulmonary Valve Replacement. JACC Case Rep 2023; 19:101926. [PMID: 37593592 PMCID: PMC10429295 DOI: 10.1016/j.jaccas.2023.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 08/19/2023]
Abstract
The presence of severe right ventricular outflow tract calcification may preclude safe and effective transcatheter pulmonary valve replacement in patients with pulmonary allograft stenosis owing to the risk of conduit tear and suboptimal annular expansion. Debulking calcium using intravascular lithotripsy within the right ventricular outflow tract may mitigate this risk and improve valve hemodynamics. (Level of Difficulty: Advanced.).
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17
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Houeijeh A, Sudre A, Juthier F, Godart F. Pulmonary valve replacement in a large and tortuous right ventricle outflow tract with a 32 mm Myval valve under local anaesthesia: challenges and technical considerations: a case report. Eur Heart J Case Rep 2023; 7:ytad322. [PMID: 37547365 PMCID: PMC10404027 DOI: 10.1093/ehjcr/ytad322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/01/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
Background Pulmonary valve replacement in patients with congenital heart diseases and heart failure is challenging. Case summary Here, we describe a case of a patient who had surgical fallot repair with chronic heart failure. Investigations found severe biventricular dysfunction and enlargement due to chronic pulmonary regurgitation. The right ventricle outflow tract was tortuous and large with a diameter of 35 mm. Percutaneous pulmonary valve implantation (PPVI) was done after a challenging pre-stenting. A 32 mm Myval valve over-sized to 35 mm was used for PPVI, which yielded a good result. Discussion A 32 mm Myval valve is effective at extending the possibilities of PPVI in a large and tortuous right ventricle outflow tract not accessible for the other valves.
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Affiliation(s)
| | - Arnaud Sudre
- Cardiac Functional Explorations and Catheterization Unit, ICP, Lille University Hospital, rue Pr. Leclerc, Lille University, UFR3S, 59000 Lille, France
| | - Francis Juthier
- Cardiac Surgery Unit, Lille University Hospital, ICP, rue de Pr.Leclerc Lille University, UFR3S, 59000 Lille, France
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18
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Misra A, Desai AS, Valente AM. Valvular Regurgitation in Adults with Congenital Heart Disease and Heart Failure: Current Status and Potential Interventions. Heart Fail Clin 2023; 19:345-356. [PMID: 37230649 DOI: 10.1016/j.hfc.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The great majority of patients born with congenital heart disease (CHD) are living well into adulthood, yet they often have residual hemodynamic lesions, including valvar regurgitation. As these complex patients grow older, they are at risk of developing heart failure, which can be exacerbated by the underlying valvular regurgitation. In this review, we describe the etiologies of heart failure related to valvular regurgitation in the CHD population and discuss potential interventions.
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Affiliation(s)
- Amrit Misra
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood, Boston, MA 02115, USA; Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Akshay S Desai
- Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood, Boston, MA 02115, USA; Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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19
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Crago M, Winlaw DS, Farajikhah S, Dehghani F, Naficy S. Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies. Bioeng Transl Med 2023; 8:e10501. [PMID: 37476058 PMCID: PMC10354783 DOI: 10.1002/btm2.10501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 03/06/2023] Open
Abstract
Congenital heart diseases (CHDs) frequently impact the right ventricular outflow tract, resulting in a significant incidence of pulmonary valve replacement in the pediatric population. While contemporary pediatric pulmonary valve replacements (PPVRs) allow satisfactory patient survival, their biocompatibility and durability remain suboptimal and repeat operations are commonplace, especially for very young patients. This places enormous physical, financial, and psychological burdens on patients and their parents, highlighting an urgent clinical need for better PPVRs. An important reason for the clinical failure of PPVRs is biofouling, which instigates various adverse biological responses such as thrombosis and infection, promoting research into various antifouling chemistries that may find utility in PPVR materials. Another significant contributor is the inevitability of somatic growth in pediatric patients, causing structural discrepancies between the patient and PPVR, stimulating the development of various growth-accommodating heart valve prototypes. This review offers an interdisciplinary perspective on these challenges by exploring clinical experiences, physiological understandings, and bioengineering technologies that may contribute to device development. It thus aims to provide an insight into the design requirements of next-generation PPVRs to advance clinical outcomes and promote patient quality of life.
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Affiliation(s)
- Matthew Crago
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
| | - David S. Winlaw
- Department of Cardiothoracic SurgeryHeart Institute, Cincinnati Children's HospitalCincinnatiOHUSA
| | - Syamak Farajikhah
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
| | - Fariba Dehghani
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
| | - Sina Naficy
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
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20
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Tan W, Aboulhosn J. Catheter-based Interventions to Reduce or Modify Surgical Risk in High-Risk Adult Congenital Heart Disease Patients. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 26:89-97. [PMID: 36842803 DOI: 10.1053/j.pcsu.2022.12.005] [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: 10/12/2022] [Revised: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022]
Abstract
The field of adult congenital heart disease has changed greatly over the past sixty years. As patients are now surviving longer into adulthood due to various improvements in surgical technique and medical technology, the demographic of patients with congenital heart disease (CHD) has changed, such that there are now more adults with CHD than there are children with CHD. This older and more medically complex population needs more interventions to treat residual defects or sequelae of their initial surgeries, and many of these patients are now deemed high risk for surgery. When the surgical risk becomes too great, either due to patient complexity, surgical complexity, or both, then transcatheter procedures may have a role in either mitigating or avoiding the risk altogether.
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Affiliation(s)
- Weiyi Tan
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Adult Congenital Heart Disease, Dallas, Texas.
| | - Jamil Aboulhosn
- Division of Cardiology, Department of Medicine, University of California Los Angeles, Adult Congenital Heart Disease, Los Angeles, California
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21
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Lourtet-Hascoët J, Valdeolmillos E, Houeijeh A, Kantzis M, Alvarez-Fuente M, Guérin P, Jones M, Georgiev S, Ystgaard MB, Betrian P, Fraisse A, Hascoët S. SAPIEN valve infective endocarditis after transcatheter pulmonary valve replacement: A European case series. Arch Cardiovasc Dis 2023; 116:109-111. [PMID: 36669930 DOI: 10.1016/j.acvd.2022.11.005] [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: 09/11/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Julie Lourtet-Hascoët
- Clinical Microbiology Laboratory, Saint Joseph Hospital, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France; Department of Paediatric Cardiology, Royal Brompton Hospital, SW3 6NP London, UK
| | - Estibaliz Valdeolmillos
- Marie-Lannelongue Hospital, M3C Network, groupe hospitalier Paris Saint-Joseph, Paris-Saclay University, 92350 Le Plessis-Robinson, France; Inserm UMR-S 999, Marie-Lannelongue Hospital, Paris-Saclay University, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France
| | - Ali Houeijeh
- Department of Congenital Heart Disease, Lille University Hospital, 59000 Lille, France
| | - Marinos Kantzis
- Department of Congenital Heart Disease, University Hospital of Leicester, LE3 9QP Leicester, UK
| | - Maria Alvarez-Fuente
- Department of Paediatric Cardiology and ACHD, Ramón y Cajal University Hospital, 28034 Madrid, Spain
| | - Patrice Guérin
- Department of Cardiology, Nantes University Hospital, 44093 Nantes, France
| | - Matthew Jones
- Department of Paediatric Cardiology, Evelina London Children's Hospital, SE1 7EH, London, UK
| | | | | | - Pedro Betrian
- Department of Paediatric Cardiology, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital, SW3 6NP London, UK
| | - Sebastien Hascoët
- Department of Paediatric Cardiology, Royal Brompton Hospital, SW3 6NP London, UK; Marie-Lannelongue Hospital, M3C Network, groupe hospitalier Paris Saint-Joseph, Paris-Saclay University, 92350 Le Plessis-Robinson, France; Inserm UMR-S 999, Marie-Lannelongue Hospital, Paris-Saclay University, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France.
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22
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Chau AK. Transcatheter pulmonary valve replacement in congenital heart diseases. Pediatr Investig 2022; 6:280-290. [PMID: 36582274 PMCID: PMC9789934 DOI: 10.1002/ped4.12359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Surgical repair of a variety of congenital heart diseases involves repair of the right ventricular outflow tract (RVOT) with valved or non-valved conduit to connect the right ventricle (RV) to the pulmonary artery (PA) or just patch enlargement of the native RVOT. With time, this RV-PA conduit will degenerate with deterioration of function, either causing pulmonary stenosis or pulmonary regurgitation. This RVOT dysfunction may result in RV dilation, RV dysfunction, and eventual RV failure and arrhythmias. Multiple surgical pulmonary valve replacement (PVR) is often required throughout the patient's lifetime. Patients are subjected to increased risks with each additional cardiac operation. Transcatheter PVR (TPVR) has been developed over the past two decades as a valuable non-surgical alternative to restore the RVOT and RV function, and hence reduce patients' lifetime risks related to surgery. This article will discuss the long-term results of TPVR which are demonstrated to be comparable to surgical results and the latest development of large pulmonary valves which will allow TPVR to be performed on native or larger RVOT.
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Affiliation(s)
- Adolphus Kai‐Tung Chau
- Department of PaediatricsThe Chinese University of Hong Kong Medical CentreHong KongChina
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23
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Bullock-Palmer RP, Bravo-Jaimes K, Mamas MA, Grines CL. Socioeconomic Factors and their Impact on Access and Use of Coronary and Structural Interventions. Eur Cardiol 2022; 17:e19. [PMID: 36643068 PMCID: PMC9820075 DOI: 10.15420/ecr.2022.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 01/18/2023] Open
Abstract
In the past few decades, the accelerated improvement in technology has allowed the development of new and effective coronary and structural heart disease interventions. There has been inequitable patient access to these advanced therapies and significant disparities have affected patients from low socioeconomic positions. In the US, these disparities mostly affect women, black and hispanic communities who are overrepresented in low socioeconomic. Other adverse social determinants of health influenced by structural racism have also contributed to these disparities. In this article, we review the literature on disparities in access and use of coronary and structural interventions; delineate the possible reasons underlying these disparities; and highlight potential solutions at the government, healthcare system, community and individual levels.
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Affiliation(s)
| | - Katia Bravo-Jaimes
- Division of Cardiology, Department of Internal Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, University of CaliforniaLos Angeles, CA, US
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele UniversityKeele, UK
| | - Cindy L Grines
- Division of Cardiology, Department of Internal Medicine, Northside Cardiovascular Institute, Northside HospitalAtlanta, GA, US
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24
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Pugliese L, Ricci F, Luciano A, De Stasio V, Presicce M, Spiritigliozzi L, Di Tosto F, Di Donna C, D'Errico F, Benelli L, Pasqualetto M, Grimaldi F, Mecchia D, Sbordone P, Cesareni M, Cerimele C, Cerocchi M, Laudazi M, Leomanni P, Rellini C, Dell'Olio V, Patanè A, Romeo F, Barillà F, Garaci F, Floris R, Chiocchi M. Role of computed tomography in transcatheter replacement of 'other valves': a comprehensive review of preprocedural imaging. J Cardiovasc Med (Hagerstown) 2022; 23:575-588. [PMID: 35994705 DOI: 10.2459/jcm.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transcatheter procedures for heart valve repair or replacement represent a valid alternative for treating patients who are inoperable or at a high risk for open-heart surgery. The transcatheter approach has become predominant over surgical intervention for aortic valve disease, but it is also increasingly utilized for diseases of the 'other valves', that is the mitral and, to a lesser extent, tricuspid and pulmonary valve. Preprocedural imaging is essential for planning the transcatheter intervention and computed tomography has become the main imaging modality by providing information that can guide the type of treatment and choice of device as well as predict outcome and prevent complications. In particular, preprocedural computed tomography is useful for providing anatomic details and simulating the effects of device implantation using 3D models. Transcatheter mitral valve replacement is indicated for the treatment of mitral regurgitation, either primary or secondary, and computed tomography is crucial for the success of the procedure. It allows evaluating the mitral valve apparatus, the surrounding structures and the left heart chambers, identifying the best access route and the landing zone and myocardial shelf, and predicting obstruction of the left ventricular outflow tract, which is the most frequent postprocedural complication. Tricuspid valve regurgitation with or without stenosis and pulmonary valve stenosis and regurgitation can also be treated using a transcatheter approach. Computer tomography provides information on the tricuspid and pulmonary valve apparatus, the structures that are spatially related to it and may be affected by the procedure, the right heart chambers and the right ventricular outflow tract.
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Affiliation(s)
- Luca Pugliese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesca Ricci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Alessandra Luciano
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Matteo Presicce
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Luigi Spiritigliozzi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Federica Di Tosto
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesca D'Errico
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Leonardo Benelli
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Monia Pasqualetto
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesco Grimaldi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Daniele Mecchia
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Paolo Sbordone
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Matteo Cesareni
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Cecilia Cerimele
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Martina Cerocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Mario Laudazi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Paola Leomanni
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Carlotta Rellini
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Vito Dell'Olio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Alberto Patanè
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesco Romeo
- Department of System Medicine, University of Rome Tor Vergata and Unit of Cardiology and Interventional Cardiology, Policlinico Tor Vergata, Rome, Italy
| | - Francesco Barillà
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesco Garaci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Roberto Floris
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
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25
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Li YJ, Pan X, Wang C, He B. Case report: Transcatheter pulmonary valve-in-valve implantation in a deteriorated self-expandable valve caused by infective endocarditis. Front Cardiovasc Med 2022; 9:939297. [PMID: 36093149 PMCID: PMC9449311 DOI: 10.3389/fcvm.2022.939297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Infective endocarditis is a complication with high mortality in patients with congenital heart disease, particularly for those with bioprosthetic valve. Case summary We report a case of a 54-year-old female with a history of tetralogy of Fallot who had been surgically repaired using a transannular patch due to severe pulmonary insufficiency with right heart enlargement and presented with worsening dyspnea. She had received transcatheter pulmonary valve implantation (TPVI) 5 years ago. Unfortunately, bioprosthesis-associated infective endocarditis occurred due to dental caries. Given persistent antibiotic medication, she became clinically stable with prosthesis functional recovery. However, dysfunctional bioprosthesis was still detected 3 years later, which was successfully treated by valve-in-valve TPVI with the help of modified buddy wire technique. At a 12-month follow-up after valve-in-valve TPVI, she was completely recovered with improved symptoms of heart failure. Conclusion This is the first report of valve-in-valve TPVI of a self-expandable valve in a degenerated self-expandable valve. The case highlights increased surveillance for infective endocarditis of transcatheter pulmonary valve should be emphasized. Subsequent valve-in-valve TPVI is an effective treatment for valve failure in defined conditions improving the hemodynamics.
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26
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In-Hospital Outcomes of Surgical and Percutaneous Pulmonary Valve Implantation in Germany. JACC Cardiovasc Interv 2022; 15:1493-1495. [PMID: 35863804 DOI: 10.1016/j.jcin.2022.04.016] [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: 03/23/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/21/2022]
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27
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Reply: Risk of Endocarditis Extension in Ross Reintervention With Transcatheter Pulmonary Valve Replacement. J Am Coll Cardiol 2022; 79:e459. [PMID: 35618355 DOI: 10.1016/j.jacc.2022.03.360] [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: 03/07/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022]
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28
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Chen L, Hammoud MS, Ghandour H, Frankel WC, Karamlou T. Risk of Endocarditis Extension in Ross Reintervention With Transcatheter Pulmonary Valve Replacement. J Am Coll Cardiol 2022; 79:e457. [PMID: 35618354 DOI: 10.1016/j.jacc.2022.01.055] [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: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
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29
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Coronary Artery Compression in Percutaneous Pulmonary Valve Implantation: Go the Distance. JACC Cardiovasc Interv 2022; 15:989-991. [PMID: 35512923 DOI: 10.1016/j.jcin.2022.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 11/20/2022]
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30
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Fraisse A, Kempny A, Bautista-Rodriguez C. Outcome After Transcatheter Pulmonary Valve Replacement: Are We Focusing on the Long Term Now? J Am Coll Cardiol 2022; 79:33-34. [PMID: 34991786 DOI: 10.1016/j.jacc.2021.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield National Health Service Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Alexander Kempny
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield National Health Service Foundation Trust, London, United Kingdom; Adult Congenital Heart Disease Unit, Royal Brompton Hospital and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Carles Bautista-Rodriguez
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield National Health Service Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom. https://twitter.com/carlesbautista
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