1
|
Bobylev D, Hysko K, Avsar M, Cvitkovic T, Petena E, Sarikouch S, Bleck MW, Hansmann G, Haverich A, Horke A. Simultaneous Aortic and Pulmonary Valve Replacement in Repaired Congenital Heart Disease. Thorac Cardiovasc Surg 2024; 72:358-365. [PMID: 36822229 PMCID: PMC11288660 DOI: 10.1055/a-2041-3528] [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: 12/08/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES Patients with congenital heart disease frequently require surgical or percutaneous interventional valve replacement after initial congenital heart defect (CHD) repair. In some of these patients, simultaneous replacement of both semilunar valves is necessary, resulting in increased procedural complexity, morbidity, and mortality. In this study, we analyze the outcomes of simultaneous aortic and pulmonary valve replacements following multiple surgical interventions for CHD. METHODS This was a retrospective study of 24 patients who after initial repair of CHD underwent single-stage aortic and pulmonary valve replacement at our institution between 2003 and 2021. RESULTS The mean age of the patients was 28 ± 13 years; the mean time since the last surgery was 15 ± 11 years. Decellularized valved homografts (DVHs) were used in nine patients, and mechanical valves were implanted in seven others. In eight patients, DVHs, biological, and mechanical valves were implanted in various combinations. The mean cardiopulmonary bypass time was 303 ± 104 minutes, and aortic cross-clamp time was 152 ± 73 minutes. Two patients died at 12 and 16 days postoperatively. At a maximum follow-up time of 17 years (mean 7 ± 5 years), 95% of the surviving patients were categorized as New York Heart Association heart failure class I. CONCLUSION Single-stage aortic and pulmonary valve replacement after initial repair of CHD remains challenging with substantial perioperative mortality (8.3%). Nevertheless, long-term survival and clinical status at the latest follow-up were excellent. The valve type had no relevant impact on the postoperative course. The selection of the valves for implantation should take into account operation-specific factors-in particular reoperability-as well as the patients' wishes.
Collapse
Affiliation(s)
- Dmitry Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Klea Hysko
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Tomislav Cvitkovic
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Elena Petena
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Mechthild Westhoff Bleck
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Ragheb DK, Martin E, Jaggi A, Lui GK, Maskatia SA, Ma M, Hanley FL, McElhinney DB. Short- and Mid-Term Results of Pulmonary Valve Replacement with the Inspiris Valve. Ann Thorac Surg 2024; 117:1203-1210. [PMID: 37625611 DOI: 10.1016/j.athoracsur.2023.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/24/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Various bioprosthetic valves are used off-label for pulmonary valve replacement (PVR), but there is no consensus on whether a particular valve is best for this application. Recently, the Inspiris Resilia valve (Edwards Lifesciences Inc) was approved for aortic valve replacement, and surgeons have begun using it for PVR. There is limited evidence on the performance of the Inspiris valve compared with other valves in the pulmonary position. METHODS This study reviewed all patients who underwent PVR with a size 19- to 29-mm Inspiris valve or Mosaic valve (Medtronic Inc) from 2007 to 2022 at Lucile Packard Children's Hospital Stanford (Palo Alto, CA). Midterm outcomes included freedom from moderate or severe pulmonary regurgitation (PR), a maximum Doppler gradient ≥36 mm Hg, and freedom from reintervention. RESULTS A total of 225 consecutive patients who underwent PVR with a size 19- to 29-mm Mosaic (n = 163) or Inspiris (n = 62) valve were included. There was no difference in baseline characteristics. Early postoperative gradients were low in both groups but higher in the Mosaic cohort, and neither group had more than mild PR on discharge. On univariable and multivariable analysis, Inspiris valves were significantly more likely to develop moderate or greater PR over time. There was no significant difference between the valves in freedom from reintervention or from a maximum gradient ≥36 mm Hg. CONCLUSIONS Early and short-term gradients were similar in patients undergoing PVR with Inspiris and Mosaic valves, but significant PR was more common in patients who received an Inspiris valve. These preliminary findings suggest that the durability of the Inspiris valve in the pulmonary position may not be superior to that of other bioprosthetic valves used for PVR.
Collapse
Affiliation(s)
- Daniel K Ragheb
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Elisabeth Martin
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Ayush Jaggi
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - George K Lui
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Shiraz A Maskatia
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Michael Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
| |
Collapse
|
4
|
Shikata F, Miyaji K. The use of Inspiris Resilia valves in the pulmonary position for repaired congenital heart defects. J Thorac Cardiovasc Surg 2024; 167:e170-e171. [PMID: 38402471 DOI: 10.1016/j.jtcvs.2024.01.036] [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: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Fumiaki Shikata
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| |
Collapse
|
5
|
Nguyen SN, Vinogradsky AV, Bacha EA, Goldstone AB. Reply: Inspiris durability in the pulmonic position: Age may matter, but more than for other valves? J Thorac Cardiovasc Surg 2024:S0022-5223(24)00205-8. [PMID: 38583163 DOI: 10.1016/j.jtcvs.2024.03.004] [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: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Stephanie N Nguyen
- Section of Pediatric and Congenital Cardiac Surgery, Columbia University Irving Medical Center, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY
| | - Alice V Vinogradsky
- Section of Pediatric and Congenital Cardiac Surgery, Columbia University Irving Medical Center, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY
| | - Emile A Bacha
- Section of Pediatric and Congenital Cardiac Surgery, Columbia University Irving Medical Center, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY
| | - Andrew B Goldstone
- Section of Pediatric and Congenital Cardiac Surgery, Columbia University Irving Medical Center, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY
| |
Collapse
|
6
|
Kim ER, Lee C, Lee CH, Cho SH. Long-term Outcomes of Polytetrafluoroethylene Bicuspid Pulmonary Valve Replacement. Ann Thorac Surg 2024; 117:535-541. [PMID: 37666352 DOI: 10.1016/j.athoracsur.2023.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/22/2023] [Accepted: 08/07/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND In 2016 we reported promising midterm outcomes of bicuspid pulmonary valve replacement using 0.1-mm polytetrafluoroethylene (PTFE) membrane. This follow-up study analyzes long-term outcomes and risk factors for reintervention and structural valve deterioration (SVD). METHODS We performed a retrospective review of the original 119 patients who underwent PTFE bicuspid pulmonary valve replacement. Median patient age was 16.9 years (range, 0.4-57.1). Reintervention was defined as any surgical or percutaneous catheter procedure on the PTFE valve. SVD was defined as development of a peak pressure gradient ≥ 50 mm Hg or at least a moderate amount of pulmonary regurgitation on follow-up echocardiography. RESULTS The median follow-up duration was 9.5 years. The survival rate was 96.5% at 5 and 10 years, with 2 early and 2 late mortalities. Freedom from reintervention was 90.0% at 5 years and 63.3% at 10 years. Freedom from SVD was 92.8% at 5 years and 51.1% at 10 years, with regurgitation the predominant mode (64.6%). Freedom from both reintervention and SVD at 5 and 10 years were 89.1% and 49.5%, respectively. Multivariable analysis identified smaller valve diameter (hazard ratio, 0.82; P < .001) and more than trivial pulmonary regurgitation at discharge (hazard ratio, 5.81; P < .001) as risk factors for reintervention or SVD. CONCLUSIONS Long-term results of the PTFE bicuspid pulmonary valve replacement were acceptable. However, improvements may be needed to reduce technical error and improve durability. Smaller valve diameter and more than trivial pulmonary regurgitation at discharge were risk factors for reintervention or SVD, warranting careful follow-up for timely reintervention.
Collapse
Affiliation(s)
- Eung Re Kim
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Chang-Ha Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Sang-Hoon Cho
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| |
Collapse
|
7
|
Gröning M, Smerup MH, Munk K, Andersen H, Nielsen DG, Nissen H, Mortensen UM, Jensen AS, Bække PS, Bjerre J, Engholm M, Vejlstrup N, Juul K, Søndergaard EV, Thyregod HGH, Andersen HØ, Helvind M, De Backer O, Jøns C, Schmidt MR, Jørgensen TH, Sondergaard L. Pulmonary Valve Replacement in Tetralogy of Fallot: Procedural Volume and Durability of Bioprosthetic Pulmonary Valves. JACC Cardiovasc Interv 2024; 17:217-227. [PMID: 38127022 DOI: 10.1016/j.jcin.2023.10.070] [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: 07/18/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Robust data on changes in pulmonary valve replacement (PVR) procedural volume and predictors of bioprosthetic pulmonary valve (BPV) durability in patients with tetralogy of Fallot (TOF) are scarce. OBJECTIVES This study sought to assess temporal trends in PVR procedural volume and BPV durability in a nationwide, retrospective TOF cohort. METHODS Data were obtained from patient records. Robust linear regression was used to assess temporal trends in PVR procedural volume. Piecewise exponential additive mixed models were used to estimate BPV durability, defined as the time from implantation to redo PVR with death as a competing risk, and to assess risk factors for reduced durability. RESULTS In total, 546 PVR were performed in 384 patients from 1976 to 2021. The annual number of PVR increased from 0.4 to 6.0 per million population (P < 0.001). In the last decade, the transcatheter PVR volume increased by 20% annually (P < 0.001), whereas the surgical PVR volume did not change significantly. The median BPV durability was 17 years (Q1: 10-Q3: 10 years-not applicable). There was no significant difference in the durability of different BPV after adjustment for confounders. Age at PVR (HR: 0.78 per 10 years from <1 year; 95% CI: 0.63-0.96; P = 0.02) and true inner valve diameter (9-17 mm vs 18-22 mm HR: 0.40; 95% CI: 0.22-0.73; P = 0.003 and 18-22 mm vs 23-30 mm HR: 0.59; 95% CI: 0.25-1.39; P = 0.23) were associated with reduced BPV durability in multivariate models. CONCLUSIONS The PVR procedural volume has increased over time, with a greater increment in transcatheter than surgical PVR during the last decade. Younger patient age at PVR and a smaller true inner valve diameter predicted reduced BPV durability.
Collapse
Affiliation(s)
- Mathis Gröning
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
| | - Morten Holdgaard Smerup
- Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Munk
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Helle Andersen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Pernille Steen Bække
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Bjerre
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Engholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus Juul
- Department of Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Henrik Ørbæk Andersen
- Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Helvind
- Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Jøns
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Rahbek Schmidt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lars Sondergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
8
|
Müller M, Biermann D, Righa MM, Carstens H, Kozlik-Feldmann RG, Hübler M, Sachweh JS. The Ongoing Debate: Longevity of Biological Valves in Pulmonary Position. Thorac Cardiovasc Surg 2024; 72:e1-e6. [PMID: 38688313 DOI: 10.1055/a-2316-8828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND In patients with tetralogy of Fallot (ToF) or ToF-like anatomy, factors possibly impacting the longevity of biological valves in the pulmonary position were investigated. METHOD Between 1997 and 2017, 79 consecutive hospital survivors with a median age of 8.7 years (range: 0.2-56.1 years; interquartile range [IQR]: 14.8 years) with ToF or ToF-like anatomy underwent surgical implantation of Contegra (n = 34), Hancock (n = 23), Perimount (n = 9), pulmonary homograft (n = 9), and miscellaneous (n = 4) conduits. The median internal graft diameter was 19 mm (range: 11-29 mm; IQR: 8 mm) which refers to a median z-score of 0.6 standard deviation (SD) (range: -1.8 to 4.0 SD; IQR: 2.1 SD). RESULTS The median time of follow-up was 9.4 years (range: 1.1-18.8 years; IQR: 6.0 years). Thirty-nine patients (49%) underwent surgical (n = 32) or interventional (n = 7) pulmonary valve re-replacement. Univariate Cox regression revealed patient age (p = 0.018), body surface area (p = 0.004), internal valve diameter (p = 0.005), and prosthesis z-score (p = 0.018) to impact valve longevity. Multivariate Cox regression analysis, however, did not show any significant effect (likely related to multicollinearity). Subgroup analysis showed that valve-revised patients have a higher average z-score (p = 0.003) and younger average age (p = 0.007). CONCLUSION A decreased longevity of biological valves in the pulmonary position is related to younger age, lower valve diameter, and higher z-score. Because valve size (diameter and z-score) can be predicted by age, patient age is the crucial parameter influencing graft longevity.
Collapse
Affiliation(s)
- Marlene Müller
- Bereich Kinderherzchirurgie/Chirurgie angeborener Herzfehler, Klinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Biermann
- Bereich Kinderherzchirurgie/Chirurgie angeborener Herzfehler, Klinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Miriam Mkanyika Righa
- Bereich Kinderherzchirurgie/Chirurgie angeborener Herzfehler, Klinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Carstens
- Bereich Kinderherzchirurgie/Chirurgie angeborener Herzfehler, Klinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Gerhard Kozlik-Feldmann
- Bereich Kinderkardiologie, Klinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hübler
- Bereich Kinderherzchirurgie/Chirurgie angeborener Herzfehler, Klinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Siegmar Sachweh
- Bereich Kinderherzchirurgie/Chirurgie angeborener Herzfehler, Klinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
9
|
Sengupta A, Pastuszko P, Zaidi AN, Murthy RA. Early Outcomes of Pulmonary Valve Replacement With the Edwards Inspiris Resilia Pericardial Bioprosthesis. World J Pediatr Congenit Heart Surg 2024; 15:52-59. [PMID: 37722839 DOI: 10.1177/21501351231178750] [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: 09/20/2023]
Abstract
BACKGROUND Controversy regarding the optimal pulmonary valve substitute remains, with no approved surgical valve for pulmonary valve replacement (PVR). Furthermore, unfavorable anatomy often precludes transcatheter PVR in patients with congenital heart disease. We therefore sought to evaluate the feasibility of the Edwards Inspiris pericardial aortic bioprosthesis in the pulmonary position in pediatric and adult patients requiring PVR. METHODS Data from consecutive patients who underwent PVR from February 2019 to February 2021 at our institution were retrospectively reviewed. Postoperative adverse events included paravalvular or transvalvular leak, endocarditis, explant, thromboembolism, valve thrombosis, valve-related bleeding, hemolysis, and structural valve degeneration. Progression of valve gradients was assessed from discharge to 30 days and one year. RESULTS Of 24 patients with median age of 26 years (interquartile range [IQR]: 17-33; range: 4-60 years), 22 (91.7%) patients had previously undergone tetralogy of Fallot repair and 2 (8.3%) patients had undergone double-outlet right ventricle repair in the neonatal period or infancy. All patients had at least mild right ventricular (RV) dilatation (median RV end-diastolic volume index 161.4, IQR: 152.3-183.5 mL/m2) and at least moderate pulmonary insufficiency (95.8%) or stenosis (8.3%). Median cardiopulmonary bypass and cross-clamp times were 71 (IQR: 63-101) min and 66 (IQR: 60-114) min, respectively. At a median postoperative follow-up of 2.5 years (IQR: 1.4-2.6; range: 1.0-3.0 years), there were no mortalities, valve-related reoperations, or adverse events. Postoperative valve gradients and the severity of pulmonary regurgitation did not change significantly over time. CONCLUSIONS At short-term follow-up, the bioprosthesis in this study demonstrated excellent safety and effectiveness for PVR. Further studies with longer follow-up are warranted.
Collapse
Affiliation(s)
- Aditya Sengupta
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Peter Pastuszko
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, New York, NY, USA
| | - Ali N Zaidi
- Mount Sinai Kravis Children's Heart Center, New York, NY, USA
| | - Raghav A Murthy
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, New York, NY, USA
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Patel PM, Zapata D, Qu W, Callahan M, Rao N, Kelleman M, Kanter KR, Chai PJ, Shaw FR, Shashidharan S, Rosenblum JM. Bioprosthetic Pulmonary Valve Dysfunction in Congenital Heart Disease. Ann Thorac Surg 2023; 115:641-648. [PMID: 35031286 DOI: 10.1016/j.athoracsur.2021.12.025] [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: 02/12/2021] [Revised: 11/21/2021] [Accepted: 12/10/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND We aim to identify the incidence and timing of dysfunction and failure of stented bioprosthetic valves in the pulmonary position in congenital heart disease patients. METHODS A total of 482 congenital heart disease patients underwent 484 stented bioprosthetic pulmonary valve implantations between 2008 and 2018. There were 164 porcine valves (Porcine) and 320 bovine pericardial valves (Pericardial) implanted. Primary endpoints were survival, valve dysfunction, and valve failure. RESULTS Pericardial valves were implanted in older patients (22.0, interquartile range [IQR] 14-33 vs 16.0, IQR 11-23 years, P < 0.001). Five-year survival (96.7% vs 97.9%) for the Pericardial and Porcine groups, respectively, were similar, P > 0.05. Forty-six (34%) Porcine and 75 (27%) Pericardial group patients met criteria for valve dysfunction at a median echocardiographic follow-up time of 7.43 years (IQR 4.1-9.5 years) and 3.26 years (IQR 1.7-4.7 years), respectively. More Pericardial group patients suffered from at least mild late PR while late median peak gradient was higher in the Porcine group, P < .001 for both. Risk factors for valve dysfunction included decreasing patient age for the entire cohort (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.00-1.04, P = .015) and lack of anticoagulation at discharge for the Porcine group (HR 3.06, 95% CI 1.03-9.10, P = .044) but not the Pericardial group. Five-year cumulative incidence of dysfunction was 39% for the Pericardial group and 17% for the Porcine group. CONCLUSIONS Porcine stented and bovine pericardial stented valves can be implanted in the pulmonary position in all age groups safely. However, despite similar rates of valve failure, bovine pericardial stented valves have a higher incidence of valve dysfunction at mid-term follow-up.
Collapse
Affiliation(s)
- Parth M Patel
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia.
| | - David Zapata
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| | - William Qu
- Emory University School of Medicine, Atlanta, Georgia
| | - Mia Callahan
- Emory University School of Medicine, Atlanta, Georgia
| | - Nikita Rao
- Children's Hospital of Atlanta, Atlanta, Georgia
| | - Michael Kelleman
- Department of Biostatistics, Rollins School of Public Health, Atlanta, Georgia
| | - Kirk R Kanter
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia; Children's Hospital of Atlanta, Atlanta, Georgia
| | - Paul J Chai
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia; Children's Hospital of Atlanta, Atlanta, Georgia
| | - Fawwaz R Shaw
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia; Children's Hospital of Atlanta, Atlanta, Georgia
| | - Subhadra Shashidharan
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia; Children's Hospital of Atlanta, Atlanta, Georgia
| | - Joshua M Rosenblum
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia; Children's Hospital of Atlanta, Atlanta, Georgia
| |
Collapse
|
12
|
Nelson JS, Bacha E, Porras D, Fuller S. Trends in Pulmonary Valve Replacement. Semin Thorac Cardiovasc Surg 2023; 35:324-332. [PMID: 36599796 DOI: 10.1053/j.semtcvs.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Jennifer S Nelson
- Department of Cardiovascular Services, Nemours Children's Health, Florida and Department of Surgery, University of Central Florida College of Medicine, Orlando, Florida.
| | - Emile Bacha
- Department of Surgery, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Diego Porras
- Division of Invasive Cardiology, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
13
|
Kwon MH, Baird CW. Surgical Valve Choices for Pulmonary Valve Replacement. Semin Thorac Cardiovasc Surg 2023; 35:94-104. [PMID: 35139432 DOI: 10.1053/j.semtcvs.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 11/11/2022]
Abstract
The range of valve choices available to the cardiac surgeon for placement in the pulmonary position continues to expand. This article will provide a brief compendium of the most clinically relevant among these choices and review the contemporary literature regarding their relative durability as well as risk factors for structural valve deterioration and reintervention. The unique advantages and disadvantages of each of these valve choices will be discussed as they pertain to unique patient-specific factors, including patient size and the anatomy of the right ventricular outflow tract, that inform the choice of one prosthesis over another. Finally, general principles regarding the approach to valve choice, and future directions will be discussed.
Collapse
Affiliation(s)
- Michael H Kwon
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
14
|
Paediatrician's guide to post-operative care for biventricular CHD: a review. Cardiol Young 2022; 32:1721-1727. [PMID: 36165406 DOI: 10.1017/s1047951122002955] [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] [Indexed: 11/07/2022]
Abstract
IMPORTANCE Paediatricians play an integral role in the lifelong care of children with CHD, many of whom will undergo cardiac surgery. There is a paucity of literature for the paediatrician regarding the post-operative care of such patients. OBSERVATIONS The aim of this manuscript is to summarise essential principles and pertinent lesion-specific context for the care of patients who have undergone surgery or intervention resulting in a biventricular circulation. CONCLUSIONS AND RELEVANCE Familiarity with common issues following cardiac surgery or intervention, as well as key details regarding specific lesions and surgeries, will aid the paediatrician in providing optimal care for these patients.
Collapse
|
15
|
Katz AJ, Lion RP, Martens T, Newcombe J, Razzouk A, Shih W, Amirnovin R, Gordon BM. Pediatric Surgical Pulmonary Valve Replacement Outcomes After Implementation of a Clinical Pathway. World J Pediatr Congenit Heart Surg 2022; 13:420-425. [PMID: 35757942 DOI: 10.1177/21501351221098127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Standardization of perioperative care can reduce resource utilization while improving patient outcomes. We sought to describe our outcomes after the implementation of a perioperative clinical pathway for pediatric patients undergoing elective surgical pulmonary valve replacement and compare these results to previously published national benchmarks. METHODS A retrospective single-center descriptive study was conducted of all pediatric patients who underwent surgical pulmonary valve replacement from 2017 through 2020, after the implementation of a clinical pathway. Outcomes included hospital length of stay and 30-day reintervention, readmission, and mortality. RESULTS Thirty-three patients (55% female, median age 11 [7, 13] years, 32 [23, 44] kg) were included in the study. Most common diagnosis and indication for surgery was Tetralogy of Fallot (61%) with pulmonary valve insufficiency (88%). All patients had prior cardiac surgery. Median hospital length of stay was 2 [2, 2] days, and longest length of stay was three days. There were no 30-day readmissions, reinterventions, or mortalities. Median follow-up time was 19 [9, 31] months. CONCLUSIONS Formalization of a perioperative surgical pulmonary valve replacement clinical pathway can safely promote short hospital length of stay without any short-term readmissions or reinterventions, especially when compared with previously published benchmarks. Such formalization enables the dissemination of best practices to other institutions to reduce hospital length of stay and limit costs.
Collapse
Affiliation(s)
- Alex J Katz
- Department of Pediatrics, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Richard P Lion
- Department of Pediatrics, Division of Critical Care, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Timothy Martens
- Department of Cardiovascular and Thoracic Surgery, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Jennifer Newcombe
- Department of Cardiovascular and Thoracic Surgery, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Anees Razzouk
- Department of Cardiovascular and Thoracic Surgery, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Wendy Shih
- School of Public Health, 4608Loma Linda University, Loma Linda, CA, USA
| | - Rambod Amirnovin
- Department of Pediatrics, Division of Critical Care, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Brent M Gordon
- Department of Pediatrics, Division of Cardiology, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| |
Collapse
|
16
|
Kalfa D. Novel Valve Choices for Pulmonary Valve Replacement. Semin Thorac Cardiovasc Surg 2022; 35:523-529. [PMID: 35032644 DOI: 10.1053/j.semtcvs.2021.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022]
Affiliation(s)
- David Kalfa
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital and Cardiac Surgery, Morgan Stanley Children Hospital -New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York.
| |
Collapse
|
17
|
Preliminary Results with a Novel expanded Polytetrafluoroethylene-based Pulmonary Valved Conduit. Ann Thorac Surg 2021; 114:2314-2321. [PMID: 34838744 DOI: 10.1016/j.athoracsur.2021.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND A novel polymeric pulmonary valved conduit, resistant to calcification and structural valve deterioration, may provide a more durable therapy option for the pediatric population by preventing loss of right ventricular function and increasing freedom from valve-related reintervention and mortality. METHODS This was a prospective, multicenter, single-arm study evaluating safety and performance of an investigational novel ePTFE-based valve. Patients met study inclusion/exclusion criteria, had a signed informed consent, had pre- and post-operative evaluation via transthoracic echocardiography and six-month cardiac magnetic resonance imaging (cMRI). RESULTS Seventeen patients were enrolled from 3 sites. Median age was 12 years (range, 6-17) with 52.9% male. BSA ranged from 0.82 to 1.57 m2. There has been no mortality and 100% freedom from device related reinterventions. Baseline compared to six-month cMRI (in 11 of 16 patients with available data) suggests favorable right ventricular remodeling (RVEDV 123±37 to 94±25 mL/m2) with no significant change in ejection fraction. Through current follow-up, no patient has an RVOT gradient > 20 mmHg, (mean 11.2 ± 4.3 mmHg). No evidence of worsening valvular insufficiency was observed throughout postoperative serial TTE evaluations. No pulmonary regurgitation above baseline (≤ mild) was observed. No patient developed endocarditis. No thrombus or calcification was identified. CONCLUSIONS This preliminary evaluation of a novel ePTFE-based valved conduit suggests promising valve function with no thromboembolic or infectious complications, no valve related reinterventions, no valve-related adverse events or unexpected findings, improved right ventricular volumes, and encouraging hemodynamic performance through current follow-up.
Collapse
|
18
|
Early failure of a bioprosthetic valve in the pulmonary position causing panic. Ann Thorac Surg 2021; 114:e13-e15. [PMID: 34637769 DOI: 10.1016/j.athoracsur.2021.09.013] [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: 08/18/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 11/22/2022]
Abstract
An asymptomatic twenty-six-year-old woman with repaired tetralogy of Fallot and a bioprosthetic pulmonary valve presented with a large thrombosis occluding most of her right ventricular outflow tract and main pulmonary arteries. Our Pulmonary Embolism Response Team (PERT) was emergently consulted resulting in considerable discussion regarding treatment modality given the large size and high-risk nature of the thrombosis. Ultimately, she was started on a heparin infusion until she could undergo open thrombectomy and pulmonary valve re-replacement. The patient's asymptomatic presentation despite the considerable clot burden complicated our approach to management but ultimately led to a measured and timely intervention.
Collapse
|
19
|
Gnanalingam C, Wright M, Ahmed Y. Pulmonary artery sarcoma masquerading as a pulmonary embolism. BMJ Case Rep 2021; 14:e232676. [PMID: 33637489 PMCID: PMC7919568 DOI: 10.1136/bcr-2019-232676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/04/2022] Open
Abstract
A 52-year-old woman was referred to the respiratory team with worsening shortness of breath for the last 3 months, which had deteriorated significantly over the last 2-3 weeks. She underwent a CT pulmonary angiogram, which was reported locally as showing a large pulmonary embolism. Given the chronic history and appearance of the thrombus, the patient was referred to a specialist pulmonary vascular disease multidisciplinary team and underwent a PET-CT scan with the diagnosis being felt to be more consistent with a pulmonary artery sarcoma. Within 4 weeks, she underwent a pulmonary endarterectomy which confirmed the presence of an extensive mass. She underwent bilateral endarterectomy and pulmonary artery valve replacement, with subsequent improvement of her breathlessness back to premorbid baseline. Postoperative histology has confirmed a pulmonary artery angiosarcoma. Alternate imaging modalities and early referral to a specialist unit allowed as early a diagnosis as possible with good symptomatic benefit.
Collapse
Affiliation(s)
| | - Matthew Wright
- Respiratory Medicine, Southend Hospital, Westcliff-on-Sea, Essex, UK
| | - Yasser Ahmed
- Respiratory Medicine, Southend Hospital, Westcliff-on-Sea, Essex, UK
| |
Collapse
|
20
|
Commentary: In pursuit of the perfect pulmonary valve…. J Thorac Cardiovasc Surg 2020; 161:365-367. [PMID: 32921441 DOI: 10.1016/j.jtcvs.2020.08.036] [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: 08/12/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/21/2022]
|
21
|
Burkhart HM, Phillips SD. Commentary: Pulmonary valve bioprosthesis: Longevity and reintervention. J Thorac Cardiovasc Surg 2020; 161:364-365. [PMID: 32859415 DOI: 10.1016/j.jtcvs.2020.08.003] [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: 08/02/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Harold M Burkhart
- Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
| | | |
Collapse
|
22
|
Quintessenza J. Commentary: Pulmonary valve replacement: A good option with room for improvement. J Thorac Cardiovasc Surg 2020; 161:363. [PMID: 32800362 DOI: 10.1016/j.jtcvs.2020.07.042] [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: 07/11/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- James Quintessenza
- Department of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, St Petersburg, Fla.
| |
Collapse
|