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Shibbani K, Aboulhosn J, Levi D, Mohammad Nijres B, Blais B, Karimi M, Van Arsdell G, Aldoss O. Hybrid approach for harmony transcatheter pulmonary valve replacement. Catheter Cardiovasc Interv 2023; 101:135-139. [PMID: 36434791 PMCID: PMC10099905 DOI: 10.1002/ccd.30504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/08/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
The Harmony™ Transcatheter Pulmonary Valve (Medtronic) was recently approved by the Food and Drug Administration for transcatheter pulmonary valve replacement in native right ventricular outflow tracts. Despite this milestone, some patients have main pulmonary arteries that are severely dilated and continue to require surgical pulmonary valve replacement. The hybrid approach combines surgical creation of a landing zone, transcatheter valve deployment, and suture stabilization of the implanted valve. In this case series, we report the first use of a hybrid approach for Harmony™ transcatheter pulmonary valve replacement. Two cases are reported with varying approaches for surgical creation of a landing zone followed by successful placement of a Harmony™ valve.
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Affiliation(s)
- Kamel Shibbani
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Jamil Aboulhosn
- Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel Levi
- Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California, USA
| | | | - Benjamin Blais
- Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California, USA
| | - Mohsen Karimi
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Glen Van Arsdell
- Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California, USA
| | - Osamah Aldoss
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
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Carr K, Nijres BM, Windsor JJ, Nakamura Y, Karimi M, Ricci M, Aldoss O. Single‐Center Experience of Hybrid Pulmonary Valve Replacement Using Left Anterior Thoracotomy With Pulmonary Artery Plication in Patients With Large Right Ventricular Outflow Tract. J Am Heart Assoc 2022; 11:e026517. [PMID: 35861815 PMCID: PMC9707832 DOI: 10.1161/jaha.122.026517] [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] [Indexed: 11/16/2022]
Abstract
Background
Until recently, a large right ventricle outflow tract interfered with the feasibility of standard transcatheter pulmonary valve replacement (PVR). We are describing our experience using a hybrid approach for PVR using a left anterior thoracotomy approach to allow for plication of the main pulmonary artery followed by a transcatheter PVR using a Sapien S3 valve.
Methods and Results
This is a single‐center, retrospective review of patients who were evaluated to be appropriate for a hybrid PVR approach. The patients' demographics, procedure details, and follow‐up data were collected. Between May 2018 and April 2021, a total of 11 patients presented for hybrid transcatheter PVR. The median age and weight were 24 years (interquartile range, 19–43 years) and 81.8 kg (interquartile range, 69–91 kg), respectively. Nine out of 11 patients received a transcatheter PVR after main pulmonary artery plication. There were no procedurally related deaths. One major complication was encountered in which the valve was malpositioned requiring successful surgical PVR. Minor complications included acute kidney injury (n=1) and a broken rib (n=1). The median length of stay was 4 days (interquartile range, 2–4 days), with median follow‐up of 7 months (interquartile range, 3–18 months). A well‐functioning pulmonary valve was observed in all patients at the last follow‐up.
Conclusions
A hybrid approach using left anterior thoracotomy with pulmonary artery plication followed by transcatheter Sapien S3 PVR provides a less‐invasive option for patients with an enlarged right ventricular outflow tract. Preliminary results demonstrated this to be a safe option with good short‐term outcomes.
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Affiliation(s)
- Kaitlin Carr
- Division of Pediatric Cardiology University of Iowa Stead Family Children’s Hospital Iowa City IA
| | - Bassel Mohmmad Nijres
- Division of Pediatric Cardiology University of Iowa Stead Family Children’s Hospital Iowa City IA
| | - Jimmy J. Windsor
- Division of Pediatric Anesthesia, Department of Anesthesia University of Iowa Iowa City IA
| | - Yuki Nakamura
- Department of Cardiothoracic Surgery University of Iowa Iowa City IA
| | - Mohsen Karimi
- Department of Cardiothoracic Surgery University of Iowa Iowa City IA
| | - Marco Ricci
- Department of Cardiothoracic Surgery University of Iowa Iowa City IA
| | - Osamah Aldoss
- Division of Pediatric Cardiology University of Iowa Stead Family Children’s Hospital Iowa City IA
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Surman TL, Abrahams JM, Manavis J, Finnie J, Christou C, Williams GK, Walls A, Frantzis P, Adams M, Edwards J, Worthington MG, Beltrame J. The susceptibility of the aortic root: porcine aortic rupture testing under cardiopulmonary bypass. J Cardiothorac Surg 2021; 16:283. [PMID: 34602088 PMCID: PMC8489069 DOI: 10.1186/s13019-021-01667-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background In our earlier study on the functional limits of the aneurysmal aortic root we determined the pig root is susceptible to failure at high aortic pressures levels. We established a pig rupture model using cardiopulmonary bypass to determine the most susceptible region of the aortic root under the highest pressures achievable using continuous flow, and what changes occur in these regions on a macroscopic and histological level. This information may help guide clinical management of aortic root and ascending aorta pathology.
Methods Five pigs underwent 4D flow MRI imaging pre surgery to determine vasopressor induced wall sheer stress and flow parameters. All pigs were then placed on cardiopulmonary bypass (CPB) via median sternotomy, and maximal aortic root and ascending aorta flows were initiated until rupture or failure, to determine the most susceptible region of the aorta. The heart was explanted and analysed histologically to determine if histological changes mirror the macroscopic observations.
Results The magnetic resonance imaging (MRI) aortic flow and wall sheer stress (WSS) increased significantly in all regions of the aorta, and the median maximal pressures obtained during cardiopulmonary bypass was 497 mmHg and median maximal flows was 3.96 L/m. The area of failure in all experiments was the non-coronary cusp of the aortic valve. Collagen and elastin composition (%) was greatest in the proximal regions of the aorta. Collagen I and III showed greatest content in the inner aortic root and ascending aorta regions. Conclusions This unique porcine model shows that the aortic root is most susceptible to failure at high continuous aortic pressures, supported histologically by different changes in collagen content and subtypes in the aortic root. With further analysis, this information could guide management of the aortic root in disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01667-9.
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Affiliation(s)
- Timothy Luke Surman
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
| | - John Matthew Abrahams
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Jim Manavis
- Department of Medical and Health Sciences, University of Adelaide Health Sciences, Adelaide, SA, Australia
| | - John Finnie
- Department of Medical and Health Sciences, University of Adelaide Health Sciences, Adelaide, SA, Australia
| | - Chris Christou
- Preclinical, Imaging, and Research Laboratories, South Australian Health and Medical Research Institute, Gilles Plains, Adelaide, SA, Australia
| | - Georgia Kate Williams
- Preclinical, Imaging, and Research Laboratories, South Australian Health and Medical Research Institute, Gilles Plains, Adelaide, SA, Australia.,National Imaging Facility, Brisbane, Australia
| | - Angela Walls
- Dr Jones and Partners, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Peter Frantzis
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Mark Adams
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - James Edwards
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - John Beltrame
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Cardiology Department, The Queen Elizabeth Hospital, Adelaide, SA, Australia
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