1
|
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
|
2
|
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
|
3
|
O'Halloran CP, Franklin WH, Tannous P. Intentional Bioprosthetic Valve Ring Fracture Causing Coronary Artery Compression During Transcatheter Pulmonary Valve Replacement. JACC Cardiovasc Interv 2024; 17:307-309. [PMID: 37999709 DOI: 10.1016/j.jcin.2023.10.005] [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: 09/06/2023] [Accepted: 10/03/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Conor P O'Halloran
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Wayne H Franklin
- Department of Pediatrics, Loyola University Medical Center, Maywood, Illinois, USA
| | - Paul Tannous
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Meier D, Puehler T, Lutter G, Shen C, Lai A, Gill H, Akodad M, Tzimas G, Chhatriwalla A, Allen KB, Blanke P, Payne GW, Wood DA, Leipsic JA, Webb JG, Sellers SL, Sathananthan J. Bioprosthetic Valve Remodeling in Nonfracturable Surgical Valves: Impact on THV Expansion and Hydrodynamic Performance. JACC Cardiovasc Interv 2023; 16:1594-1608. [PMID: 37294230 DOI: 10.1016/j.jcin.2023.03.035] [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: 01/11/2023] [Revised: 02/13/2023] [Accepted: 03/21/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND There are limited data on the effect of bioprosthetic valve remodeling (BVR) on transcatheter heart valve (THV) expansion and function following valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) in a nonfracturable surgical heart valve (SHV). OBJECTIVES This study sought to assess the impact of BVR of nonfracturable SHVs on THVs after VIV implantation. METHODS VIV TAVR was performed using 23-mm SAPIEN3 (S3, Edwards Lifesciences) or 23/26-mm Evolut Pro (Medtronic) THVs implanted in 21/23-mm Trifecta (Abbott Structural Heart) and 21/23-mm Hancock (Medtronic) SHVs with BVR performed with a noncompliant TRUE balloon (Bard Peripheral Vascular Inc). Hydrodynamic assessment was performed, and multimodality imaging including micro-computed tomography was performed before and after BVR to assess THV and SHV expansion. RESULTS BVR resulted in limited improvement of THV expansion. The largest gain in expansion was observed for the S3 in the 21-mm Trifecta with up to a 12.7% increase in expansion at the outflow of the valve. Minimal change was observed at the level of the sewing ring. The Hancock was less amenable to BVR with lower final expansion dimensions than the Trifecta. BVR also resulted in notable surgical post flaring of up to 17.6°, which was generally more marked with the S3 than with the Evolut Pro. Finally, BVR resulted in very limited improvement in hydrodynamic function. Severe pinwheeling was observed with the S3, which improved slightly but persisted despite BVR. CONCLUSIONS When performing VIV TAVR inside a Trifecta and Hancock SHV, BVR had a limited impact on THV expansion and resulted in SHV post flaring with unknown consequences on coronary obstruction risk and long-term THV function.
Collapse
Affiliation(s)
- David Meier
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Puehler
- German Centre for Cardiovascular Research, Partner Site Kiel/Hamburg/Lübeck, Kiel Germany; Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holsten, Campus Kiel, Kiel, Germany
| | - Georg Lutter
- German Centre for Cardiovascular Research, Partner Site Kiel/Hamburg/Lübeck, Kiel Germany; Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holsten, Campus Kiel, Kiel, Germany
| | - Carol Shen
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Althea Lai
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Hacina Gill
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Mariama Akodad
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Ramsay Santé, Institut Cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Massy, France
| | - Georgios Tzimas
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adnan Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David A Wood
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon A Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie L Sellers
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
7
|
Staged Percutaneous Management of Pulmonary Atresia and Intact Interventricular Septum: Stretching the Limits. J Interv Cardiol 2023; 2023:9709227. [PMID: 36793670 PMCID: PMC9908361 DOI: 10.1155/2023/9709227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/24/2022] [Accepted: 12/12/2022] [Indexed: 02/04/2023] Open
Abstract
Aims Pulmonary atresia with intact ventricular septum (PA/IVS) can be treated by catheter-based interventions and complemented by various surgical procedures. We aim to determine a long-term treatment strategy to enable patients to be surgery free, depending solely on percutaneous interventions. Methods and Results We selected five patients from among a cohort of patients with PA/IVS treated at birth with radiofrequency perforation and dilatation of the pulmonary valve. Patients had reached a pulmonary valve annulus of 20 mm or larger on their biannual echocardiographic follow-up, with right ventricular dilatation. The findings, together with the right ventricular outflow tract and pulmonary arterial tree, were confirmed by multislice computerised tomography. Based on the angiographic size of the pulmonary valve annulus, all patients were successfully implanted with either Melody® or Edwards® pulmonary valves percutaneously, regardless of their small weights and ages. No complications were encountered. Conclusion We managed to stretch the age and weight limitations for performing percutaneous pulmonary valve implantation (PPVI): interventions were attempted whenever a pulmonary annulus size of >20 mm was reached, which was rationalised by the prevention of progressive right ventricular outflow tract dilatation and accommodating valves between 24 and 26 mm, which is enough to sustain a normal pulmonary flow in adulthood.
Collapse
|
8
|
Houeijeh A, Batteux C, Karsenty C, Ramdane N, Lecerf F, Valdeolmillos E, Lourtet-Hascoet J, Cohen S, Belli E, Petit J, Hascoët S. Long-term outcomes of transcatheter pulmonary valve implantation with melody and SAPIEN valves. Int J Cardiol 2023; 370:156-166. [PMID: 36283540 DOI: 10.1016/j.ijcard.2022.10.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcatheter pulmonary valve implantation (TPVI) is effective for treating right ventricle outflow tract (RVOT) dysfunction. Factors associated with long-term valve durability remain to be investigated. METHODS Consecutive patients successfully treated by TPVI with Melody valves (n = 32) and SAPIEN valves (n = 182) between 2008 and 2020 at a single tertiary centre were included prospectively and monitored. RESULTS The 214 patients had a median age of 28 years (range, 10-81). The RVOT was a patched native pulmonary artery in 96 (44.8%) patients. Median follow-up was 2.8 years (range, 3 months-11.4 years). Secondary pulmonary valve replacement (sPVR) was performed in 23 cases (10.7%), due to stenosis (n = 22, 95.7%) or severe regurgitation (n = 1, 4.3%), yielding an incidence of 7.6/100 patient-years with melody valves and 1.3/100 patient-years with SAPIEN valves (P = 0.06). The 5- and 10-year sPVR-freedom rates were 78.1% and 50.4% with Melody vs. 94.3% and 82.2% with SAPIEN, respectively (P = 0.06). The incidence of infective endocarditis (IE) was 5.5/100 patient-years with Melody and 0.2/100 patient-years with SAPIEN (P < 0.0001). Factors associated with sPVR by univariate analysis were RV obstruction before TPVI (P = 0.04), transpulmonary maximal velocity > 2.7 m/s after TPVI (p = 0.0005), valve diameter ≤ 22 mm (P < 0.003), IE (P < 0.0001), and age < 25 years at TPVI (P = 0.04). By multivariate analysis adjusted for IE occurrence, transpulmonary maximal velocity remained associated with sPVR. CONCLUSIONS TPVI is effective for treating RVOT dysfunction. Incidence of sPVR is higher in patients with residual RV obstruction or IE. IE add a substantial risk of TPVI graft failure and is mainly linked to the Melody valve. SOCIAL MEDIA ABSTRACT Transcatheter pulmonary valve implantation is effective for treating right ventricular outflow tract dysfunction in patients with congenital heart diseases. Incidence of secondary valve replacement is higher in patients with residual obstruction or infective endocarditis.
Collapse
Affiliation(s)
- Ali Houeijeh
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France; Department of Congenital Heart Disease, Lille University Hospital, Faculté de médecine, Laboratoire EA4489, Université Lille II, Lille, France.
| | - Clement Batteux
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| | - Clement Karsenty
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France; Service de cardiologie pédiatrique, Hôpital des Enfants, CHU de Toulouse, 330 avenue de Grande-Bretagne, Toulouse, France.
| | - Nassima Ramdane
- Department of Congenital Heart Disease, Lille University Hospital, Faculté de médecine, Laboratoire EA4489, Université Lille II, Lille, France.
| | - Florence Lecerf
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, Faculté de médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| | - Estibaliz Valdeolmillos
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, Faculté de médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| | - Julie Lourtet-Hascoet
- Service de microbiologie Clinique, Hôpital Saint-Joseph, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, Paris, France.
| | - Sarah Cohen
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| | - Emre Belli
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| | - Jérôme Petit
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| | - Sébastien Hascoët
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, Faculté de médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| |
Collapse
|
9
|
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.
Collapse
Affiliation(s)
- Adolphus Kai‐Tung Chau
- Department of PaediatricsThe Chinese University of Hong Kong Medical CentreHong KongChina
| |
Collapse
|
10
|
Canan A, Ocazionez-Trujillo D, Vargas D, Foley TA, Cabalka AK, Rajiah PS. Pre- and Postprocedure Imaging of Transcatheter Pulmonary Valve Implantation. Radiographics 2022; 42:991-1011. [PMID: 35687519 DOI: 10.1148/rg.210160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transcatheter pulmonary valve replacement (TPVR) is a minimally invasive procedure for treatment of right ventricular outflow tract (RVOT) dysfunction in surgically repaired congenital heart diseases. TPVR is performed in these patients to avoid the high risk and complexity of repeat surgeries. Several TPVR devices are now available to be placed in the right ventricle (RV) to pulmonary artery (PA) conduit, native RVOT, or surgical bioprosthetic valves. Imaging is used before TPVR to determine patient eligibility and optimal timing, which is critical to avoid irreversible RV dilatation and failure. Imaging is also required for evaluation of contraindications, particularly proximity of the RVOT to the left main coronary artery and its branches. Cross-sectional imaging provides details of the complex anatomy in which the TPVR device will be positioned and measurements of the RVOT, RV-PA conduit, or PA. Echocardiography is the first-line imaging modality for evaluation of the RVOT or conduit to determine the need for intervention, although its utility is limited by the complex RVOT morphology and altered anatomy after surgery. CT and MRI provide complementary information for TPVR, including patient eligibility, assessment of contraindications, and key measurements of the RVOT and PA, which are necessary for procedure planning. TPVR, performed using a cardiac catheterization procedure, includes a sizing step in which a balloon is expanded in the RVOT, which also allows assessment of the risk for extrinsic coronary artery compression. Follow-up imaging with CT and MRI is used for evaluation of postprocedure remodeling and valve function and to monitor complications. ©RSNA, 2022 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Arzu Canan
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Radiology, UT Health Sciences Center, Houston, Tex (D.O.T.); Department of Radiology, University of Colorado, Aurora, Colo (D.V.); and Department of Radiology (T.A.F., P.S.R.) and Division of Cardiology (A.K.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Daniel Ocazionez-Trujillo
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Radiology, UT Health Sciences Center, Houston, Tex (D.O.T.); Department of Radiology, University of Colorado, Aurora, Colo (D.V.); and Department of Radiology (T.A.F., P.S.R.) and Division of Cardiology (A.K.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Daniel Vargas
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Radiology, UT Health Sciences Center, Houston, Tex (D.O.T.); Department of Radiology, University of Colorado, Aurora, Colo (D.V.); and Department of Radiology (T.A.F., P.S.R.) and Division of Cardiology (A.K.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Thomas A Foley
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Radiology, UT Health Sciences Center, Houston, Tex (D.O.T.); Department of Radiology, University of Colorado, Aurora, Colo (D.V.); and Department of Radiology (T.A.F., P.S.R.) and Division of Cardiology (A.K.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Allison K Cabalka
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Radiology, UT Health Sciences Center, Houston, Tex (D.O.T.); Department of Radiology, University of Colorado, Aurora, Colo (D.V.); and Department of Radiology (T.A.F., P.S.R.) and Division of Cardiology (A.K.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Prabhakar Shantha Rajiah
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Radiology, UT Health Sciences Center, Houston, Tex (D.O.T.); Department of Radiology, University of Colorado, Aurora, Colo (D.V.); and Department of Radiology (T.A.F., P.S.R.) and Division of Cardiology (A.K.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| |
Collapse
|
11
|
Kenny D, Hijazi ZM. Transcatheter Pulmonary Valve Replacement. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
12
|
Kim WC, Taliotis D, Turner M. Transcatheter pulmonary valve implant in a patient with a previous pulmonary valve-in-valve. J Cardiol Cases 2022; 26:39-41. [DOI: 10.1016/j.jccase.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/23/2022] [Accepted: 02/19/2022] [Indexed: 11/30/2022] Open
|
13
|
Batlivala SP, Hagel JA, Hirsch R, Shahanavaz S. Transcatheter pulmonary valve-in-valve implantation within the expandable Inspiris Resilia® bioprosthetic valve. Catheter Cardiovasc Interv 2022; 99:1157-1160. [PMID: 35032141 DOI: 10.1002/ccd.30079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 11/10/2022]
Abstract
Transcatheter pulmonary valve implantation (TPVI) is a common intervention for patients with repaired congenital heart disease. A key issue relates to the presence of an appropriately sized implantation zone for the transcatheter valve. We report the first case, to our knowledge, of TPVI within the newly engineered Inspiris Resilia® bioprosthetic valve, intentionally designed with a balloon-expandable valve ring (a.k.a. VFit zone) for prospective valve implantation.
Collapse
Affiliation(s)
- Sarosh P Batlivala
- Division of Pediatric Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathon A Hagel
- Division of Pediatric Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Russel Hirsch
- Division of Pediatric Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Shabana Shahanavaz
- Division of Pediatric Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
14
|
Tanase D, Georgiev S. Concept of fracturing a small‐sized bioprothesis for further valve in valve implantation. Catheter Cardiovasc Interv 2022; 99:E47. [DOI: 10.1002/ccd.29126] [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: 04/23/2020] [Accepted: 06/14/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Daniel Tanase
- Department of Pediatric Cardiology and Congenital Heart Defects German Heart Center Germany
| | | |
Collapse
|
15
|
Jones TK, McElhinney DB, Vincent JA, Hellenbrand WE, Cheatham JP, Berman DP, Zahn EM, Khan DM, Rhodes JF, Weng S, Bergersen LJ. Long-Term Outcomes After Melody Transcatheter Pulmonary Valve Replacement in the US Investigational Device Exemption Trial. Circ Cardiovasc Interv 2021; 15:e010852. [PMID: 34930015 PMCID: PMC8765216 DOI: 10.1161/circinterventions.121.010852] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The Melody valve was developed to extend the useful life of previously implanted right ventricular outflow tract (RVOT) conduits or bioprosthetic pulmonary valves, while preserving RV function and reducing the lifetime burden of surgery for patients with complex congenital heart disease. Methods: Enrollment for the US Investigational Device Exemption study of the Melody valve began in 2007. Extended follow-up was completed in 2020. The primary outcome was freedom from transcatheter pulmonary valve (TPV) dysfunction (freedom from reoperation, reintervention, moderate or severe pulmonary regurgitation, and/or mean RVOT gradient >40 mm Hg). Secondary end points included stent fracture, catheter reintervention, surgical conduit replacement, and death. Results: One hundred seventy-one subjects with RVOT conduit or bioprosthetic pulmonary valve dysfunction were enrolled. One hundred fifty underwent Melody TPV replacement. Median age was 19 years (Q1–Q3: 15–26). Median discharge mean RVOT Doppler gradient was 17 mm Hg (Q1–Q3: 12–22). The 149 patients implanted >24 hours were followed for a median of 8.4 years (Q1–Q3: 5.4–10.1). At 10 years, estimated freedom from mortality was 90%, from reoperation 79%, and from any reintervention 60%. Ten-year freedom from TPV dysfunction was 53% and was significantly shorter in children than in adults. Estimated freedom from TPV-related endocarditis was 81% at 10 years (95% CI, 69%–89%), with an annualized rate of 2.0% per patient-year. Conclusions: Ten-year outcomes from the Melody Investigational Device Exemption trial affirm the benefits of Melody TPV replacement in the lifetime management of patients with RVOT conduits and bioprosthetic pulmonary valves by providing sustained symptomatic and hemodynamic improvement in the majority of patients. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00740870.
Collapse
Affiliation(s)
- Thomas K Jones
- Division of Cardiology, Seattle Children's Hospital, University of Washington School of Medicine (T.K.J.)
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA (D.B.M.)
| | - Julie A Vincent
- Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY (J.A.V.)
| | - William E Hellenbrand
- Division of Cardiology, Department of Pediatrics, Yale School of Medicine, New Haven, CT (W.E.H.)
| | - John P Cheatham
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (J.P.C., D.P.B.)
| | - Darren P Berman
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (J.P.C., D.P.B.)
| | - Evan M Zahn
- Guerin Family Congenital Heart Program, The Heart Institute and Department of Pediatrics, Cedars-Sinai Heart Institute, Los Angeles, CA (E.M.Z.)
| | - Danyal M Khan
- Department of Pediatric Cardiology, Niklaus Children's Hospital, Miami, FL (D.M.K.)
| | - John F Rhodes
- Congenital Heart Center, Medical University of South Carolina, Charleston (J.F.R.)
| | - Shicheng Weng
- Structural Heart and Aortic Clinical Department, Medtronic, Mounds View, MN (S.W.)
| | - Lisa J Bergersen
- Department of Cardiology, Boston Children's Hospital, MA (L.J.B.)
| |
Collapse
|
16
|
Spigel ZA, Adachi I, Binsalamah ZM, Parekh D, Qureshi AM. Transcatheter pulmonic valve implantation in adult patients with prior congenital heart surgery. Ann Cardiothorac Surg 2021; 10:658-666. [PMID: 34733693 DOI: 10.21037/acs-2021-tviv-28] [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: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
Background Transcatheter pulmonary valve replacement (TPVR) is now an established modality for pulmonary valve replacement in suitable candidates. We aim to describe our experience with TPVR in adults. Methods This is a descriptive study of all TPVR performed in adults with congenital heart disease at a single institution from 2010-2020. All adult patients (defined as 18 years old or older at TPVR) were included. Time-to-event outcomes were described using Kaplan-Meier estimates with 95% confidence intervals (CIs). Results Out of a total of 200 patients that had undergone TPVR, 81 patients (57% male) met the inclusion criteria, with a median age and weight of 26 years (IQR 21-37) and 71.0 kg (IQR 54.6-89.0), respectively. In the cohort, 45 (56%) patients had tetralogy of Fallot. While 53 (65%) patients received a Melody valve, a Sapien valve (S3 in 20, XT in eight) was implanted in the rest. Pre-stenting was performed in 49 (52%) patients. One patient died of severe heart failure a year following TPVR. One patient had a second TPVR performed 2.2 years following initial TPVR for severe pulmonary regurgitation. Valve survival at 2.2 years was 94% (95% CI: 87-100%). Four patients developed endocarditis. Endocarditis-free survival was 89% (95% CI: 80-100%) at three years. Conclusions Our experience suggests favorable results of TPVR in adults with congenital heart disease. Additional research would be warranted with a focus on total valve longevity and patient reported outcomes, in order to improve the understanding of TPVR in this population and further refine this technology.
Collapse
Affiliation(s)
- Zachary A Spigel
- Department of Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Iki Adachi
- Department of Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Ziyad M Binsalamah
- Department of Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Dhaval Parekh
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
17
|
Allen KB, Chhatriwalla AK, Saxon JT, Huded CP, Sathananthan J, Nguyen TC, Whisenant B, Webb JG. Bioprosthetic valve fracture: a practical guide. Ann Cardiothorac Surg 2021; 10:564-570. [PMID: 34733685 DOI: 10.21037/acs-2021-tviv-25] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022]
Abstract
Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) is currently indicated for the treatment of failed surgical tissue valves in patients determined to be at high surgical risk for re-operative surgical valve replacement. VIV TAVR, however, often results in suboptimal expansion of the transcatheter heart valve (THV) and can result in patient-prosthesis mismatch (PPM), particularly in small surgical valves. Bioprosthetic valve fracture (BVF) and bioprosthetic valve remodeling (BVR) can facilitate VIV TAVR by optimally expanding the THV and reducing the residual transvalvular gradient by utilizing a high-pressure inflation with a non-compliant balloon to either fracture or stretch the surgical valve ring, respectively. This article, along with the supplemental video, will provide patient selection, procedural planning and technical insights for performing BVF and BVR.
Collapse
Affiliation(s)
- Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - John T Saxon
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Chetan P Huded
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation and Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | | | | | - John G Webb
- Centre for Cardiovascular Innovation and Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| |
Collapse
|
18
|
Contrast-free percutaneous pulmonary valve replacement: a safe approach for valve-in-valve procedures. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:200-209. [PMID: 34400923 PMCID: PMC8356834 DOI: 10.5114/aic.2021.107500] [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: 10/06/2020] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Percutaneous pulmonary valve replacement (PPVI) continues to gather pace in pediatric and adult congenital practice. This is fueled by an expanding repertoire of devices, techniques and equipment to suit the heterogenous anatomical landscape of patients with lesions of the right ventricular outflow tract (RVOT). Contrast-induced nephropathy is a real risk for teenagers and adults with congenital heart disease (CHD). Aim To present a series of patients who underwent PPVI without formal RVOT angiography and propose case selection criteria for patients who may safely benefit from this approach. Material and methods We retrospectively collected PPVI data from the preceding 2 years at our institution identifying patients who had been listed as suitable for consideration for contrast-free PPVI from our multidisciplinary team (MDT) meeting based on predefined criteria. Demographic, clinical, imaging and hemodynamic data were collected. Data were analyzed using SPSS. Results Twenty-one patients were identified. All patients had a technically successful implantation with improvements seen in invasive and echocardiographic hemodynamic measurements. 90% of patients had a bio-prosthetic valve (BPV) in situ prior to PPVI. One patient had a complication which may have been recognized earlier with post-intervention RVOT contrast injection. Conclusions Zero-contrast PPVI is technically feasible and the suitability criteria for those who might benefit are potentially straightforward. The advent of fusion and 3D imaging in cardiac catheterization laboratories is likely to expand our capacity to perform more procedures with less contrast. Patients with bio-prosthetic valves in the pulmonary position may benefit from contrast-free percutaneous pulmonary valve implantation.
Collapse
|
19
|
Dorobantu DM, Sharabiani MTA, Taliotis D, Parry AJ, Tulloh RMR, Bentham JR, Caputo M, van Doorn C, Stoica SC. Age over 35 years is associated with increased mortality after pulmonary valve replacement in repaired tetralogy of Fallot: results from the UK National Congenital Heart Disease Audit database. Eur J Cardiothorac Surg 2021; 58:825-831. [PMID: 32187367 PMCID: PMC7890931 DOI: 10.1093/ejcts/ezaa069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/01/2020] [Accepted: 02/05/2020] [Indexed: 01/29/2023] Open
Affiliation(s)
- Dan M Dorobantu
- School of Sport and Health Sciences, University of Exeter, Exeter, UK.,Bristol Medical School, University of Bristol, Bristol, UK.,Department of Cardiology, "Prof. C.C. Iliescu" Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Mansour T A Sharabiani
- Department of Primary Care & Public Health, School of Public Health, Imperial College of London, London, UK
| | - Demetris Taliotis
- Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK
| | - Andrew J Parry
- Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK
| | - Robert M R Tulloh
- Bristol Medical School, University of Bristol, Bristol, UK.,Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK
| | - James R Bentham
- Departments of Cardiology and Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, UK.,Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK
| | - Carin van Doorn
- Departments of Cardiology and Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Serban C Stoica
- Bristol Medical School, University of Bristol, Bristol, UK.,Departments of Cardiology and Cardiac Surgery, The Heart Institute and Royal Hospital for Children, Bristol, UK
| |
Collapse
|
20
|
|
21
|
Law MA, Chatterjee A. Transcatheter pulmonic valve implantation: Techniques, current roles, and future implications. World J Cardiol 2021; 13:117-129. [PMID: 34131475 PMCID: PMC8173335 DOI: 10.4330/wjc.v13.i5.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/11/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
Right ventricular outflow tract (RVOT) obstruction is present in a variety of congenital heart disease states including tetralogy of Fallot, pulmonary atresia/stenosis and other conotruncal abnormalities etc. After surgical repair, these patients develop RVOT residual abnormalities of pulmonic stenosis and/or insufficiency of their native outflow tract or right ventricle to pulmonary artery conduit. There are also sequelae of other surgeries like the Ross operation for aortic valve disease that lead to right ventricle to pulmonary artery conduit dysfunction. Surgical pulmonic valve replacement (SPVR) has been the mainstay for these patients and is considered standard of care. Transcatheter pulmonic valve implantation (TPVI) was first reported in 2000 and has made strides as a comparable alternative to SPVR, being approved in the United States in 2010. We provide a comprehensive review in this space–indications for TPVI, detailed procedural facets and up-to-date review of the literature regarding outcomes of TPVI. TPVI has been shown to have favorable medium-term outcomes free of re-interventions especially after the adoption of the practice of pre-stenting the RVOT. Procedural mortality and complications are uncommon. With more experience, recognition of risk of dreaded outcomes like coronary compression has improved. Also, conduit rupture is increasingly being managed with transcatheter tools. Questions over endocarditis risk still prevail in the TPVI population. Head-to-head comparisons to SPVR are still limited but available data suggests equivalence. We also discuss newer valve technologies that have limited data currently and may have more applicability for treatment of native dysfunctional RVOT substrates.
Collapse
Affiliation(s)
- Mark Aaron Law
- Department of Pediatric Cardiology, Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Arka Chatterjee
- Division of Cardiology, University of Arizona College of Medicine, Tuscon, AZ 85724, United States
| |
Collapse
|
22
|
Maeda K, Lui GK, Zhang Y, Maskatia SA, Romfh A, Yarlagadda VV, Hanley FL, McElhinney DB. Durability of Pulmonary Valve Replacement with Large Diameter Stented Porcine Bioprostheses. Semin Thorac Cardiovasc Surg 2021; 34:994-1000. [PMID: 33971298 DOI: 10.1053/j.semtcvs.2021.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/11/2022]
Abstract
There is limited information about durability of large diameter porcine bioprostheses implanted for pulmonary valve replacement (PVR). We studied patients who underwent surgical PVR from 2002-2019 with a stented porcine bioprosthetic valve (BPV) with a labeled size ≥27 mm. The primary outcome was freedom from reintervention. During the study period, 203 patients underwent PVR using a porcine BPV ≥27 mm, 94% of whom received a Mosaic valve (Medtronic Inc., Minneapolis, MN). Twenty patients underwent reintervention from 3.4-12.0 years after PVR: 5 surgical and 15 transcatheter PVR procedures. The indication for reintervention was regurgitation in 13 patients, stenosis in 2, mixed disease in 4, and endocarditis in 1. Estimated freedom from reintervention was 97±1% at 5 years and 82±4% at 10 years, and freedom from prosthesis dysfunction (moderate or severe regurgitation and/or a maximum Doppler gradient ≥50 mm Hg) over time was 91±2% at 5 years and 74±4% at 10 years. Younger age and smaller true valve diameter were associated with shorter freedom from reintervention, but valve oversizing was not. The durability of large stented porcine bioprostheses in the pulmonary position is generally excellent, particularly in adolescents and adults, similar to various other types of BPV. In the current study, relative valve size was not associated with valve longevity, although the low event-rate in this population was a limiting factor.
Collapse
Affiliation(s)
- Katsuhide Maeda
- Departments of Cardiothoracic Surgery, Stanford University School of Medicine
| | - George K Lui
- Cardiovascular Medicine, Stanford University School of Medicine; Pediatrics, Stanford University School of Medicine
| | - Yulin Zhang
- Departments of Cardiothoracic Surgery, Stanford University School of Medicine
| | | | - Anitra Romfh
- Cardiovascular Medicine, Stanford University School of Medicine; Pediatrics, Stanford University School of Medicine
| | | | - Frank L Hanley
- Departments of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Doff B McElhinney
- Departments of Cardiothoracic Surgery, Stanford University School of Medicine; Pediatrics, Stanford University School of Medicine.
| |
Collapse
|
23
|
Sekhon S, Barger PM, Abarbanell AM. Outcomes 60 years after surgical valvotomy for isolated congenital pulmonary valve stenosis. J Card Surg 2021; 36:1531-1533. [PMID: 33522622 DOI: 10.1111/jocs.15276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
Congenital pulmonary valve stenosis (PVS) is a common congenital heart defect. In the infancy of cardiac surgery, open surgical valvotomy or closed surgical transventricular pulmonary valvotomy (Brock procedure) were the mainstays of therapy. We report the longest-known published follow-up of two women who as young children underwent pulmonary valvotomy for PVS and subsequent uncomplicated open pulmonary valve replacement over 60 years later.
Collapse
Affiliation(s)
- Subhjit Sekhon
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas, Missouri, USA
| | - Philip M Barger
- Cardiovascular Division, Department of Internal Medicine, Center for Adults with Congenital Heart Disease, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Aaron M Abarbanell
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
24
|
Daniels MJ, Garcia S. Inspiring Resilience in the Pulmonary Position – Is a Paradigm Shift Due in Congenital Heart Disease? STRUCTURAL HEART 2021. [DOI: 10.1080/24748706.2020.1846827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
25
|
Early Outcomes of Percutaneous Pulmonary Valve Implantation with Pulsta and Melody Valves: The First Report from Korea. J Clin Med 2020; 9:jcm9092769. [PMID: 32859019 PMCID: PMC7565703 DOI: 10.3390/jcm9092769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 02/05/2023] Open
Abstract
Percutaneous pulmonary valve implantation (PPVI) is used to treat pulmonary stenosis (PS) or pulmonary regurgitation (PR). We described our experience with PPVI, specifically valve-in-valve transcatheter pulmonary valve replacement using the Melody valve and novel self-expandable systems using the Pulsta valve. We reviewed data from 42 patients undergoing PPVI. Twenty-nine patients had Melody valves in mostly bioprosthetic valves, valved conduits, and homografts in the pulmonary position. Following Melody valve implantation, the peak right ventricle-to-pulmonary artery gradient decreased from 51.3 ± 11.5 to 16.7 ± 3.3 mmHg and right ventricular systolic pressure fell from 70.0 ± 16.8 to 41.3 ± 17.8 mmHg. Thirteen patients with native right ventricular outflow tract (RVOT) lesions and homograft underwent PPVI with the new self-expandable Pulsta valve—a nitinol wire stent mounted with a trileaflet porcine pericardial valve. Following Pulsta valve implantation, cardiac magnetic resonance imaging showed a decreased PR fraction and that the right ventricular end-diastolic volume index decreased from 166.1 ± 11.9 to 123.6 ± 12.4 mL/m2. There were no mortality, severe procedural morbidity, or valve-related complications. At the mean 14.2 month (4–57 months) follow-up, no patients had more than mild PR. PPVI using Melody and Pulsta valves was first shown to provide excellent early outcomes without serious adverse event in most patients with RVOT dysfunction in Korea.
Collapse
|
26
|
Kang L, Lodge AJ. Commentary: Epic Supra Valve Just as Good for Pulmonary Valve Replacement - But is it Good Enough? Semin Thorac Cardiovasc Surg 2020; 33:193-194. [PMID: 32858215 DOI: 10.1053/j.semtcvs.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/21/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Lillian Kang
- Duke University Medical Center, Department of Surgery, Durham North Carolina
| | - Andrew J Lodge
- Duke Pediatric and Congenital Heart Center, Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Durham North Carolina.
| |
Collapse
|
27
|
The Y-stenting technique for bifurcation stenosis and bioprosthetic valve frame fracture prior to valve-in-valve transcatheter pulmonary valve replacement in a child. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:206-208. [PMID: 32636908 PMCID: PMC7333195 DOI: 10.5114/aic.2020.96066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/24/2020] [Indexed: 11/17/2022] Open
|
28
|
Abstract
This article provides a detailed review of the current practices and future directions of transcatheter interventions in adults with congenital heart disease. This includes indications for intervention, risks, and potential complications, as well as a review of available devices and their performance.
Collapse
|
29
|
Shahanavaz S, Berger F, Jones TK, Kreutzer J, Vincent JA, Eicken A, Bergersen L, Rome JJ, Zahn E, Søndergaard L, Cheatham JP, Weng S, Balzer D, McElhinney D. Outcomes After Transcatheter Reintervention for Dysfunction of a Previously Implanted Transcatheter Pulmonary Valve. JACC Cardiovasc Interv 2020; 13:1529-1540. [DOI: 10.1016/j.jcin.2020.03.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/04/2020] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
|
30
|
Spigel ZA, Zhu H, Qureshi AM, Penny DJ, Caldarone CA, Heinle JS, Binsalamah ZM. Durability of the St. Jude Epic Supra Bioprosthetic Valve in the Pulmonary Position. Semin Thorac Cardiovasc Surg 2020; 33:184-191. [PMID: 32505797 DOI: 10.1053/j.semtcvs.2020.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 11/11/2022]
Abstract
Epic Supra valves have been used off-label in the pulmonary position. We aim to evaluate the durability of Epic valves in the pulmonary position. We performed a retrospective review of all Epic valves placed in the pulmonary position from October 2008 to May 2019. Time-to-event analysis was performed using Kaplan-Meier estimates to evaluate freedom from valve intervention, moderate pulmonary regurgitation, and peak velocity greater than 3.5 m/s. Valve dysfunction was a composite of all 3 end points. A total of 79 patients had Epic valves implanted in the pulmonary position. Median age was 18.5 years (15th-85th percentile 11.2-41.0). In total, 1 (1%) 19 mm valve, 4 (5%) 21 mm valves, 8 (10%) 23 mm valves, 23 (29%) 25 mm valves, and 43 (54%) 27 mm valves were implanted. There were no deaths or transplants. Median follow-up was 3.1 years (interquartile range 1.0-5.5). At 5 years, freedom from valve intervention was 95%, freedom from valve dysfunction was 68%, freedom from moderate pulmonary regurgitation was 73%, and freedom from peak velocity greater than 3.5 m/s was 82%. Epic Supra valves provide an acceptable valve replacement in the pulmonary position for children and adults. Longer follow-up is needed to determine valve durability through the entirety of the valve life expectancy.
Collapse
Affiliation(s)
- Zachary A Spigel
- Texas Children's Hospital/Baylor College of Medicine, Department of Surgery, Division of Congenital Heart Surgery, Houston, Texas
| | - Huirong Zhu
- Texas Children's Hospital/Baylor College of Medicine, Department of Surgery, Outcomes and Impact Service, Houston, Texas
| | - Athar M Qureshi
- Texas Children's Hospital/Baylor College of Medicine, Department of Pediatrics, Division of Cardiology, Houston, Texas
| | - Daniel J Penny
- Texas Children's Hospital/Baylor College of Medicine, Department of Pediatrics, Division of Cardiology, Houston, Texas
| | - Christopher A Caldarone
- Texas Children's Hospital/Baylor College of Medicine, Department of Surgery, Division of Congenital Heart Surgery, Houston, Texas
| | - Jeffrey S Heinle
- Texas Children's Hospital/Baylor College of Medicine, Department of Surgery, Division of Congenital Heart Surgery, Houston, Texas
| | - Ziyad M Binsalamah
- Texas Children's Hospital/Baylor College of Medicine, Department of Surgery, Division of Congenital Heart Surgery, Houston, Texas.
| |
Collapse
|
31
|
Langhammer F, Lehner A, Haas NA, Jakob A. Percutaneous pulmonary valve implantation in a dysfunctional Trifecta® bioprothesis after high-pressure balloon fracturing. Catheter Cardiovasc Interv 2020; 95:1310-1313. [PMID: 32073737 DOI: 10.1002/ccd.28781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 11/11/2022]
Abstract
A percutaneous pulmonary valve-in-valve (PPVIV) implantation in small surgical tissue valves may be limited due to the valve's initial diameter. Fracturing of the valve's integrity by high-pressure balloons may enhance the diameter and facilitate subsequent PPVIV with a large valve. To the best of our knowledge, the Trifecta® valve seemed not to be accessible for fracturing. We report a case of successful 19-mm Trifecta valve fracturing, followed by PPVIV using a 26-mm Edwards SAPIEN 3 valve in pulmonary position. By repetitively using a high-pressure balloon 5 mm larger than the labeled valve size, we were able to fracture the valve's integrity and implant a 26-mm valve thereafter. Therefore, Trifecta valve appears to be suitable for valve ring fracturing and subsequent PPVIV in certain patients.
Collapse
Affiliation(s)
- Florian Langhammer
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | - Anja Lehner
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | - André Jakob
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| |
Collapse
|
32
|
Alkashkari W, Albugami S, Abbadi M, Niyazi A, Alsubei A, Hijazi ZM. Transcatheter pulmonary valve replacement in pediatric patients. Expert Rev Med Devices 2020; 17:541-554. [PMID: 32459512 DOI: 10.1080/17434440.2020.1775578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Right ventricular outflow tract (RVOT) dysfunction is common among individuals with congenital heart disease (CHD). Surgical intervention often carries prohibitive risks due to the need for sequential pulmonary valve (PV) replacements throughout their life in the majority of cases. Transcatheter pulmonary valve replacement (tPVR) is one of the most exciting recent developments in the treatment of CHD and has evolved to become an attractive alternative to surgery in patients with RVOT dysfunction. AREAS COVERED In this review, we examine the pathophysiology of RVOT dysfunction, indications for tPVR, and the procedural aspect. Advancements in clinical application and valve technology will also be covered. EXPERT OPINION tPVR is widely accepted as an alternative to surgery to address RVOT dysfunction, but still significant numbers of patients with complex RVOT morphology deemed not suitable for tPVR. As the technology continues to evolve, new percutaneous valves will allow such complex RVOT patient to benefit from tPVR.
Collapse
Affiliation(s)
- Wail Alkashkari
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Saad Albugami
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Mosa Abbadi
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Akram Niyazi
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Amani Alsubei
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Ziyadi M Hijazi
- Sidra Heart Center, Sidra Medicine , Doha, Qatar.,Medical Research Department, Weill Cornell Medicine , New York, NY, USA
| |
Collapse
|
33
|
Morgan GJ, Sivakumar K, Promphan W, Goreczny S, Prachasilchai P, Qureshi S. Early clinical experience with the straight design of Venus P-valve™ in dysfunctional right ventricular outflow tracts. Catheter Cardiovasc Interv 2020; 96:E653-E659. [PMID: 32096924 DOI: 10.1002/ccd.28819] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To assess the initial procedural and short to medium-term experience with the straight design of the Venus P-valve™ (Venus MedTech, Hangzhou, China) in dysfunctional right ventricular outflow tracts (RVOT). BACKGROUND The Melody™ valve (Medtronic, Minneapolis, Minnesota) has been the only percutaneous valve option for smaller RVOT conduits. The straight Venus P-valve™ may provide an alternative to the Melody™ valve. METHODS Retrospective data collection of patient characteristics, procedural data, clinical and imaging follow-up of the straight Venus P-valve™. RESULTS Nine patients (four female) with a mean age of 23.1 ± 7.5 years and a mean weight of 72.7 ± 29.4 kg underwent straight Venus P-valve™ implantation between 03/2014 and 06/2016. All patients had right ventricle-to-pulmonary artery conduits which were pre-stented before the valve implantation. All valves were deployed successfully without any significant procedural complications. During the mean follow-up of 24 ± 9.1 months, there were no valve related re-interventions or deterioration in valve performance. There was one case of insignificant, single wire frame fracture and no cases of endocarditis. The cohort demonstrated a reduction in pulmonary regurgitation and tricuspid regurgitation, which was sustained throughout the follow-up. Similarly the gradient across the RVOT tract did not significantly increase. CONCLUSIONS Implantation of the straight Venus P-valve™ has provided satisfactory short to mid-term results with high success rates and no complications and may be considered as an alternative option in patients with RVOT dysfunction.
Collapse
Affiliation(s)
- Gareth J Morgan
- Department of Cardiology, Colorado Children's Hospital, University of Colorado Hospital, Denver, Colorado, USA.,Department of Adult Congenital Cardiology, University of Colorado Hospital, Denver, Colorado, USA.,Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Worakan Promphan
- Pediatric Cardiac Center, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Sebastian Goreczny
- Department of Cardiology, Colorado Children's Hospital, University of Colorado Hospital, Denver, Colorado, USA.,Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Lodz, Poland
| | - Pimpak Prachasilchai
- Pediatric Cardiac Center, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Shakeel Qureshi
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
34
|
Singh M, Reitknecht F, Rogers G, Kaluski E. Transcatheter valve-in-valve aortic valve replacement with bioprosthetic valve Fracture/Stretching technique in a degenerated mitroflow valve. J Cardiol Cases 2020; 21:189-192. [PMID: 32373245 DOI: 10.1016/j.jccase.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/27/2019] [Accepted: 01/07/2020] [Indexed: 11/29/2022] Open
Abstract
We describe a successful bioprosthetic annular stretching in a patient with severe prosthetic aortic valve stenosis from a degenerated 19-mm Mitroflow valve (Sorin Group USA Inc, Arvada, CO, USA). This technique allowed for implantation of a 23-mm Evolut-R Pro valve (Medtronic, Minneapolis, MN, USA) with significant improvement in hemodynamics after prosthetic annular stretching. We have also summarized other case series and case reports which have previously described similar techniques. <Learning objective: Transcatheter valve-in-valve procedure may not be feasible in certain patients who have a relatively smaller size bioprosthetic valve. Cracking/stretching the annular ring of the smaller prosthetic valve to deploy a larger transcatheter valve is a potential option in these patients. Clinicians must be cognizant of the possible pitfalls, contraindications, and other technical aspects to choose the right patient for this procedure.>.
Collapse
Affiliation(s)
- Maninder Singh
- Department of Cardiology, Guthrie Medical Group/Robert Packer Hospital, Sayre, PA, USA.,Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Felice Reitknecht
- Department of Cardiothoracic Surgery, Guthrie Medical Group/Robert Packer Hospital, Sayre, PA, USA
| | - Guy Rogers
- Department of Cardiology, Guthrie Medical Group/Robert Packer Hospital, Sayre, PA, USA
| | - Edo Kaluski
- Department of Cardiology, Guthrie Medical Group/Robert Packer Hospital, Sayre, PA, USA.,Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| |
Collapse
|
35
|
Aggarwal V, Spigel ZA, Hiremath G, Binsalamah Z, Qureshi AM. Current clinical management of dysfunctional bioprosthetic pulmonary valves. Expert Rev Cardiovasc Ther 2020; 18:7-16. [DOI: 10.1080/14779072.2020.1715796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA
| | - Zachary A Spigel
- Department of Pediatric Surgery, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Gurumurthy Hiremath
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA
| | - Ziyad Binsalamah
- Department of Pediatric Surgery, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
36
|
Edelman JJ, Khan JM, Rogers T, Shults C, Satler LF, Ben-Dor II, Waksman R, Thourani VH. Valve-in-Valve TAVR: State-of-the-Art Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:299-310. [DOI: 10.1177/1556984519858020] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An increasing number of surgically implanted bioprostheses will require re-intervention for structural valve deterioration. Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an alternative to reoperative surgery, currently approved for high-risk and inoperable patients. Challenges to the technique include higher rates of prosthesis–patient mismatch and coronary obstruction, compared to native valve TAVR. Herein, we review results of ViV TAVR and novel techniques to overcome the aforementioned challenges.
Collapse
Affiliation(s)
- J. James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Jaffar M. Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christian Shults
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Lowell F. Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - I. Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Vinod H. Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| |
Collapse
|
37
|
Tompkins R, Kelle AM, Cabalka AK, Lui GK, Aboulhosn J, Dvir D, McElhinney DB. Echocardiographic Evaluation of Patients Undergoing Transcatheter Tricuspid Valve-In-Valve Replacement. J Am Soc Echocardiogr 2019; 32:616-623. [DOI: 10.1016/j.echo.2018.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Indexed: 11/24/2022]
|
38
|
Multi-modality imaging for percutaneous pulmonary valve implantation - getting serious about radiation and contrast reduction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:110-115. [PMID: 31043993 PMCID: PMC6488842 DOI: 10.5114/aic.2019.83776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022] Open
|
39
|
Chhatriwalla AK, Sorajja P. Expanding Indications for Bioprosthetic Valve Fracture and Bioprosthetic Valve Remodeling. Circ Cardiovasc Interv 2018; 11:e007017. [PMID: 30354791 DOI: 10.1161/circinterventions.118.007017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, MN (P.S.)
| |
Collapse
|