open access

Vol 24, No 6 (2017)
Original articles — Interventional cardiology
Published online: 2017-02-15
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Immediate and long-term outcomes of percutaneous transcatheter pulmonary valve implantation

Roland Fiszer, Paweł Dryżek, Małgorzata Szkutnik, Sebastian Góreczny, Alexandra Krawczuk, Jadwiga Moll, Tomasz Moszura, Szymon Pawlak, Jacek Białkowski
DOI: 10.5603/CJ.a2017.0023
·
Pubmed: 28248409
·
Cardiol J 2017;24(6):604-611.

open access

Vol 24, No 6 (2017)
Original articles — Interventional cardiology
Published online: 2017-02-15

Abstract

Background: Transcutaneous pulmonary valve replacement (TPVR) has become an alternative to heart surgery for patients after previous right ventricular outflow tract (RVOT) or pulmonary artery (PA) surgical interventions. The objective was to present immediate and long-term outcomes of trans¬cutaneous pulmonary valve replacement. Methods: Between 06/2009 and 06/2016, 46 patients underwent TPVR. Initial diagnoses included tetralogy of Fallot, common arterial trunk, transposition of great arteries post Rastelli correction, left ventricle outflow obstruction after Ross operation, pulmonary atresia, and isolated dysplastic pulmonary valve stenosis. Thirty eight (78%) patients had previously implanted conduits in the pulmonary position, the rest had either RVOT patch reconstruction (n = 6; 13%) or biological valve implantation (n = 2; 4%). They presented primarily with pulmonary stenosis (n = 18; 39%) or regurgitation (n = 28; 60%). Results: All procedures were successful — 44 Melody and 2 Edwards-Sapien valves were implanted. Before each procedure exclusion of potential coronary compression and RVOT prestenting was performed. Significant RVOT systolic gradient reduction (from 35.3 ± 19.5 to 13.5 ± 7.1 mm Hg; p < 0.001) and decrease of right to left ventricle systolic pressure ratio from 0.58 ± 0.18 to mean 0.37 ± 0.1 (p < 0.001) was achieved. Also, in every patient PA-RVOT competence was restored, with minor in¬competence in only a few patients. Post procedure follow-up ranged from 2 to 86 (mean 35.2) months. Follow-up fluoroscopy or chest X-ray revealed 6 stent fractures (2 stent defragmentation — with only 1 significant valve stenosis). Conclusions: Transcutaneous pulmonary valve replacement is a safe procedure with encouraging results, it also enables deferring surgical reintervention in the majority of patients.

Abstract

Background: Transcutaneous pulmonary valve replacement (TPVR) has become an alternative to heart surgery for patients after previous right ventricular outflow tract (RVOT) or pulmonary artery (PA) surgical interventions. The objective was to present immediate and long-term outcomes of trans¬cutaneous pulmonary valve replacement. Methods: Between 06/2009 and 06/2016, 46 patients underwent TPVR. Initial diagnoses included tetralogy of Fallot, common arterial trunk, transposition of great arteries post Rastelli correction, left ventricle outflow obstruction after Ross operation, pulmonary atresia, and isolated dysplastic pulmonary valve stenosis. Thirty eight (78%) patients had previously implanted conduits in the pulmonary position, the rest had either RVOT patch reconstruction (n = 6; 13%) or biological valve implantation (n = 2; 4%). They presented primarily with pulmonary stenosis (n = 18; 39%) or regurgitation (n = 28; 60%). Results: All procedures were successful — 44 Melody and 2 Edwards-Sapien valves were implanted. Before each procedure exclusion of potential coronary compression and RVOT prestenting was performed. Significant RVOT systolic gradient reduction (from 35.3 ± 19.5 to 13.5 ± 7.1 mm Hg; p < 0.001) and decrease of right to left ventricle systolic pressure ratio from 0.58 ± 0.18 to mean 0.37 ± 0.1 (p < 0.001) was achieved. Also, in every patient PA-RVOT competence was restored, with minor in¬competence in only a few patients. Post procedure follow-up ranged from 2 to 86 (mean 35.2) months. Follow-up fluoroscopy or chest X-ray revealed 6 stent fractures (2 stent defragmentation — with only 1 significant valve stenosis). Conclusions: Transcutaneous pulmonary valve replacement is a safe procedure with encouraging results, it also enables deferring surgical reintervention in the majority of patients.
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Keywords

pulmonary valve, transcatheter valve implantation, congenital heart disease

About this article
Title

Immediate and long-term outcomes of percutaneous transcatheter pulmonary valve implantation

Journal

Cardiology Journal

Issue

Vol 24, No 6 (2017)

Pages

604-611

Published online

2017-02-15

DOI

10.5603/CJ.a2017.0023

Pubmed

28248409

Bibliographic record

Cardiol J 2017;24(6):604-611.

Keywords

pulmonary valve
transcatheter valve implantation
congenital heart disease

Authors

Roland Fiszer
Paweł Dryżek
Małgorzata Szkutnik
Sebastian Góreczny
Alexandra Krawczuk
Jadwiga Moll
Tomasz Moszura
Szymon Pawlak
Jacek Białkowski

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