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Odemis E, Yenidogan I, Kizilkaya MH. Early results of Pulsta® transcatheter heart valve in patients with enlarged right ventricular outflow tract and severe pulmonary regurgitation due to transannular patch. Cardiol Young 2023; 33:1926-1934. [PMID: 36380490 DOI: 10.1017/s1047951122003511] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to assess the feasibility, effectivity, and safety of a novel self-expandable valve system, Pulsta® transcatheter heart valve in patients with tetralogy of fallot and severe pulmonary regurgitation after transannular patch repair. BACKGROUND Severe pulmonary regurgitation after tetralogy of fallot repair is a life-threatening problem and should be treated by pulmonary valve implantation. Although percutaneous pulmonary valve implantation has been ever increasingly used for this purpose, available balloon-expandable valves have limitations and cannot be used by most patients. Pulsta® transcatheter heart valve is a new self-expandable valve system and offers a new solution to be used in patients with different types of native right ventricular outflow tract geometry. PATIENTS AND METHODS Ten patients with severe regurgitation after tetralogy of fallot repair with a transannular patch have been enrolled in the study according to echocardiographic examination. MRI was used in asymptomatic patients to delineate the indication and the right ventricular outflow tract geometry. Pulsta® transcatheter heart valve implantation was performed in ten patients, and preprocedural, procedure, and 6 months follow-up findings of the patients were evaluated. RESULTS Pulsta® pulmonary valve implantation was performed in ten patients successfully without any severe complications. Valve functions were perfect in six of ten patients, while the others had insignificant regurgitation by echocardiographic examination at the end of 6 months follow-up. CONCLUSIONS This study showed that Pulsta® transcatheter heart valve is a feasible, effective, and safe method in the treatment of severe pulmonary regurgitation due to transannular patch repair in patients with tetralogy of fallot.
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Affiliation(s)
- Ender Odemis
- Faculty of Medicine, Department of Pediatric Cardiology, Koc University, Istanbul, Turkey
| | - Irem Yenidogan
- Faculty of Medicine, Department of Pediatrics, Koc University, Istanbul, Turkey
| | - Mete Han Kizilkaya
- Faculty of Medicine, Department of Pediatric Cardiology, Koc University, Istanbul, Turkey
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Machanahalli Balakrishna A, Dilsaver DB, Aboeata A, Gowda RM, Goldsweig AM, Vallabhajosyula S, Anderson JH, Simard T, Jhand A. Infective Endocarditis Risk with Melody versus Sapien Valves Following Transcatheter Pulmonary Valve Implantation: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Clin Med 2023; 12:4886. [PMID: 37568289 PMCID: PMC10419461 DOI: 10.3390/jcm12154886] [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: 04/20/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Transcatheter pulmonary valve implantation (TPVI) is an effective non-surgical treatment method for patients with right ventricle outflow tract dysfunction. The Medtronic Melody and the Edwards Sapien are the two valves approved for use in TPVI. Since TPVI patients are typically younger, even a modest annual incidence of infective endocarditis (IE) is significant. Several previous studies have shown a growing risk of IE after TPVI. There is uncertainty regarding the overall incidence of IE and differences in the risk of IE between the valves. METHODS A systematic search was conducted in the MEDLINE, EMBASE, PubMed, and Cochrane databases from inception to 1 January 2023 using the search terms 'pulmonary valve implantation', 'TPVI', or 'PPVI'. The primary outcome was the pooled incidence of IE following TPVI in Melody and Sapien valves and the difference in incidence between Sapien and Melody valves. Fixed effect and random effect models were used depending on the valve. Meta-regression with random effects was conducted to test the difference in the incidence of IE between the two valves. RESULTS A total of 22 studies (including 10 Melody valve studies, 8 Sapien valve studies, and 4 studies that included both valves (572 patients that used the Sapien valve and 1395 patients that used the Melody valve)) were used for the final analysis. Zero IE incidence following TPVI was reported by eight studies (66.7%) that utilized Sapien valves compared to two studies (14.3%) that utilized Melody valves. The pooled incidence of IE following TPVI with Sapien valves was 2.1% (95% CI: 0.9% to 5.13%) compared to 8.5% (95% CI: 4.8% to 15.2%) following TPVI with Melody valves. Results of meta-regression indicated that the Sapien valve had a 79.6% (95% CI: 24.2% to 94.4%, p = 0.019; R2 = 34.4) lower risk of IE incidence compared to the Melody valve. CONCLUSIONS The risk of IE following TPVI differs significantly. A prudent valve choice in favor of Sapien valves to lower the risk of post-TPVI endocarditis may be beneficial.
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Affiliation(s)
| | - Danielle B. Dilsaver
- Department of Medicine, Division of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, NE 68124, USA
| | - Ahmed Aboeata
- Division of Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, NE 68124, USA
| | - Ramesh M. Gowda
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10029, USA
| | - Andrew M. Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA 01199, USA
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE 68105, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Jason H. Anderson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Aravdeep Jhand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Boutsikou M, Tzifa A. Non-invasive imaging prior to percutaneous pulmonary valve implantation. Hellenic J Cardiol 2022; 67:59-65. [PMID: 35863726 DOI: 10.1016/j.hjc.2022.06.004] [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: 02/27/2022] [Revised: 06/04/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022] Open
Abstract
The majority of patients with congenital heart disease who have undergone open heart surgery during childhood are possible candidates for additional transcatheter or surgical interventions. One fifth of these conditions usually involve the right ventricular outflow tract (RVOT). Percutaneous pulmonary valve replacement (PPVR) has been widely established as an alternative, less invasive option to surgical pulmonary valve replacement (SPVR). The variability of RVOT anatomy and size, the relative course of the coronary arteries and the anatomy of the pulmonary artery branches are factors that determine the success of the intervention as well as the complication rates. Careful and reliable pre-interventional imaging warrants the selection of suitable candidates and minimizes the risk of complications. 2D and 3D fluoroscopy have been extensively used during pre- and peri-interventional assessment. Established imaging techniques such as Cardiovascular Magnetic Resonance (CMR) and Computed Tomography (CT), as well as newer techniques, such as fusion imaging, have proved to be efficient and reliable tools during pre-procedural planning in patients assessed for PPVR.
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Affiliation(s)
- Maria Boutsikou
- Cardiac MRI Dpt, Mediterraneo Hospital, Ilias 8-12, Glyfada, 16674, Athens, Greece.
| | - Aphrodite Tzifa
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, Mitera Hospital, 6 Erythrou Stavrou Street, 15123, Marousi, Athens, Greece; School of Biomedical Engineering & Imaging Sciences. King's College London, United Kingdom.
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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.
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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
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Shang X, Dong N, Zhang C, Wang Y. The Clinical Trial Outcomes of Med-Zenith PT-Valve in the Treatment of Patients With Severe Pulmonary Regurgitation. Front Cardiovasc Med 2022; 9:887886. [PMID: 35783837 PMCID: PMC9243481 DOI: 10.3389/fcvm.2022.887886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Nearly 2/3 of patients with dilated right ventricular outflow tract (RVOT) were excluded from pulmonary valves transplantation due to the lack of size-matched valves. Here, we explored the safety and efficacy of the Med-Zenith PT-Valve for the treatment of patients with severe pulmonary regurgitation. Methods 22 Patients with severe PR (grade 3+,4+) were enrolled based on the anatomical features of native RVOT and the valve design. The immediate, 3-months and 1-year post-procedural follow-up data were analyzed. Results The baseline mean systolic diameters in the distal main pulmonary artery (MPA), MPA sinus junction, MPA sinus, pulmonary annulus, RVOT aneurysm and muscular outlet measured with computed tomography were 33.6 ± 6.1, 34.0 ± 5.8, 37.9 ± 6.0, 32.4 ± 7.3, 41.9 ± 9.3, and 34.4 ± 8.0 mm, respectively. The PT-Valve landing zone was set within these levels. Successful valve implantations were achieved in all patients without noticeable device malposition, coronary artery compression, pulmonary branch obstruction or paravalvular leak during follow-ups. Post-procedural pulmonary artery diastolic pressure increased from 5.8 ± 3.1 to 11.3 ± 2.5 mmHg. In the 3-month and 1-year follow-up, the right ventricular end diastolic volume index reduced from the baseline 181.6 ± 29.0 to 143.7 ± 29.7 ml/m2 and 123.4 ± 31.2 ml/m2, and the trans-pulmonary valve gradient decreased from 25.6 ± 22.2 to 10.64 ± 3.54 mmHg and 11.16 ± 3.0 mmHg, respectively. The 6-min walk distance increased from 416.6 ± 97.9 to 455.9 ± 64.6 m and 467.8 ± 61.2 m, respectively. Conclusion This clinical trial revealed favorable outcomes for the safety, efficacy and feasibility of the Med-Zenith PT-Valve in the treatment of severe PR with significantly enlarged RVOT.
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Affiliation(s)
- Xiaoke Shang
- Department of General Medicine and Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Changdong Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanggan Wang
- Department of General Medicine and Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Medical Research Institute of Wuhan University, Wuhan University, Wuhan, China
- *Correspondence: Yanggan Wang
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Fujimoto K, Kitano M, Sakaguchi H, Ohuchi H, Hoashi T, Ichikawa H, Shiraishi I, Kurosaki K. Morphological changes and number of candidates for transcatheter pulmonary valve implantation in conduits involving heterograft and artificial material. Heart Vessels 2021; 36:1384-1391. [PMID: 33649908 DOI: 10.1007/s00380-021-01808-z] [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: 10/13/2020] [Accepted: 02/12/2021] [Indexed: 11/28/2022]
Abstract
Heterograft and artificial materials have been used for extracardiac conduit implantation to create right ventricular (RV) to pulmonary artery (PA) continuity for biventricular repair in Japan because of the limited availability of homograft valves. However, few studies have examined morphological changes and number of candidates for transcatheter pulmonary valve implantation (TPVI) in which the conduit includes more than one type of material. Overall, 88 patients who underwent biventricular repair with an external conduit were included in this evaluation. Based on catheterization data and surgical records, we estimated morphological change in the RV outflow tract for each material and the number of candidates for Melody valve implantation based on premarket approval application criteria established by the U.S. Food and Drug Administration. There were 63 candidates for TPVI (72%, 63/88). Median anteroposterior and lateral diameter of the RV outflow tract was 20.4 mm (range 9.0-41.5) and 17.8 mm (range 9.5-34.9), respectively. Bovine pericardium tended to dilate by 11.2%. Polytetrafluoroethylene (ePTFE), homograft, and Dacron polyethylene terephthalate (PET) tended to become stenotic by 11.1%, 28.0%, and 13.4%, respectively. While ePTFE (27/33, 82%) and Dacron PET (2/2, 100%) were highly suitable for TPVI, bovine pericardium (32/48, 67%) was less suitable. In Japan, many patients with hemodynamic indications for TPVI following extracardiac conduit implantation to create RV to PA continuity may also meet the morphological indications.
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Affiliation(s)
- Kazuto Fujimoto
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Masataka Kitano
- Department of Pediatric Cardiology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hideo Ohuchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
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Transcatheter pulmonary valve implantation in 100 patients: a 10-year single-center experience. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:235-243. [PMID: 33597988 PMCID: PMC7863798 DOI: 10.5114/aic.2020.99257] [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: 08/12/2020] [Accepted: 08/30/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Transcatheter pulmonary valve implantation (TPVI) is a non-surgical method of treatment for patients with right ventricular outflow tract (RVOT) dysfunction after surgical repair of congenital heart defects (CHD). Aim To evaluate the long-term results of TPVI performed in a single center. Material and methods: Over 10 years, TPVI was performed in 100 patients (mean age: 26.4 ±8.1 years), using Melody Medtronic or Sapien Edwards valves. Results The initial success rate of TPVI was 93%. In 7 cases (5 urgent), a switch to surgical intervention was necessary due to periprocedural complications (all patients survived). Following TPVI, none of the 93 patients had severe pulmonary regurgitation. The pulmonary gradient decreased from 49.0 ±37.8 before to 27.6 ±14.9 mm Hg directly after TPVI (p < 0.0001). Right ventricular end-diastolic volume decreased, while NYHA class and pVO2 uptake significantly improved in 1 year after TPVI. Freedom from reintervention was 100% in 1 year. Freedom from serious adverse events was 86% in mean 5.5 years of observation. The main reason for reintervention was infective endocarditis (IE) (1.6% patients/year). Increased risk of IE was associated with severe PS before valve implantation and the suboptimal result of TPVI. The incidence of IE seems to be lower in patients treated permanently with antiplatelet therapy (1.8% vs. 0.9% patients/year, NS). Conclusions TPVI is a safe and effective method of treatment in patients with RVOT dysfunction after surgical correction of CHD. To achieve a good outcome, precise patient selection and rigorous IE prevention are necessary.
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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.
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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
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Implantation of the Edwards SAPIEN XT and SAPIEN 3 valves for pulmonary position in enlarged native right ventricular outflow tract. Anatol J Cardiol 2020; 25:96-103. [PMID: 33583816 DOI: 10.14744/anatoljcardiol.2020.46024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Percutaneous pulmonary valve implantation (PPVI) into right ventricle-to-pulmonary artery conduits is increasingly being performed, but a few options are available for patients with a dilated native right ventricular outflow tract (RVOT), among which is the off-label use of Ed-wards SAPIEN® valves. This study reviews the results of the SAPIEN XT and SAPIEN 3 (S3) valve implantations in the pulmonary position in patients with a dilated native RVOT. METHODS Between January 2015 and March 2020, PPVI procedures were performed on 129 patients. Among them, 103 (80%) had dilated native RVOT, 86 of whom were eligible for PPVI prestenting and valve implantation. Retrospective analysis was performed on 84 patients who have undergone successful PPVI implantation using the SAPIEN XT or S3 valves with dilated native RVOT. RESULTS The procedural success rate was 84/86 (98%). The median age was 18.7 years (8-46 years), and the median weight was 57 kg (22-102 kg). The primary underlying diagnosis was tetralogy of Fallot (n=77/84). Stenting was performed simultaneously with valve implantation in 50/84 (60%) cases-six of which were hybrid procedures-whereas prestenting was performed 3 to 14 weeks earlier in 34/84 cases. Before valve im-plantation, the median right anterior oblique and lateral diameters of the stents were 26 mm (20-32 mm) and 28 mm (21-32 mm). Valve sizes were 26 mm (n=13) and 29 mm (n=64) for XT and 29 mm (n=7) for S3. In 59 patients, an additional 1-5 ml (median 2 ml) volume was added to the valves' balloons for stabilization. In all hybrid procedures, the stent and valve were implanted in the same session. During follow-ups of 1 to 59 months (median 14 months), no deaths were reported, 3 patients developed tricuspid regurgitation secondary to the procedure, and valves continued to function in all patients. CONCLUSION The Edwards SAPIEN XT and S3 valves may be an alternative to PPVI in patients with dilated native RVOT.
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Greutmann M, Benson L, Silversides CK. Percutaneous Valve Interventions in the Adult Congenital Heart Disease Population: Emerging Technologies and Indications. Can J Cardiol 2019; 35:1740-1749. [PMID: 31813506 DOI: 10.1016/j.cjca.2019.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 11/28/2022] Open
Abstract
Adult survivors with congenital heart disease are not cured and residual cardiac valve lesions are common and contribute substantially to long-term morbidity. Given the increased risk of reoperations in patients with previous cardiac surgery, percutaneous treatment options have been developed. Initially percutaneous therapies focused on right ventricular outflow tract lesions, but they have now expanded to include mitral and aortic valve interventions. Although some of these procedures, such as balloon valvuloplasty of pulmonary valve stenosis and percutaneous pulmonary valve replacement, have become standard of care, there are many new and evolving technologies that will likely become important treatment strategies over the coming decade. The key for success of these transcatheter valve procedures is the careful evaluation of the patient's individual anatomy and physiology and a multidisciplinary assessment involving cardiologists specialized in adult congenital heart disease, specialized imagers, cardiac surgeons, and interventionalists. Because many of these percutaneous interventions are relatively new, long-term outcomes are not yet well defined, dictating the need for careful and structured long-term observational studies on outcomes of these novel procedures, which will allow refining the indications of a specific intervention and to improve its technical aspects. The aim of this article is to provide an overview of common valve lesions in the adult congenital heart disease population and to discuss treatment options and strategies with a specific focus on percutaneous options.
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Affiliation(s)
- Matthias Greutmann
- University Heart Centre, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
| | - Lee Benson
- Toronto Congenital Cardiac Centre for Adults, University Health Network, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada; Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Candice K Silversides
- Toronto Congenital Cardiac Centre for Adults, Division of Cardiology, University of Toronto, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
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The risk of infective endocarditis following interventional pulmonary valve implantation: A meta-analysis. J Cardiol 2019; 74:197-205. [DOI: 10.1016/j.jjcc.2019.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/22/2019] [Accepted: 04/13/2019] [Indexed: 11/19/2022]
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Role of cardiovascular magnetic resonance end-systolic 3D-SSFP sequence in repaired tetralogy of Fallot patients eligible for transcatheter pulmonary valve implantation. Int J Cardiovasc Imaging 2019; 35:1525-1533. [PMID: 31161492 DOI: 10.1007/s10554-019-01630-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
To evaluate the usefulness of cardiovascular magnetic resonance (CMR) 3D steady state free precession (SSFP) sequence acquired at end-systole (ES) in repaired Tetralogy of Fallot (rToF) patients eligible for percutaneous pulmonary valve implantation (PPVI). Between 2012 and 2018, 78 rToF patients were selected for pulmonary valve replacement (PVR) according to CMR criteria. CMR protocol included 3D-SSFP sequence used to assess the right ventricle outflow tract (RVOT) diameters at three levels (pulmonary valve remnant, mid-portion, bifurcation) in mid-diastole (MD) or ES, RVOT length and coronary artery anatomy. In 20 rToF patients without indications for PVR (controls), 3D SSFP sequence was acquired at both cardiac phases (MD and ES) to evaluate RVOT dimension throughout the cardiac cycle. Invasive balloon sizing was recorded in patients undergoing PPVI. The 3D-SSFP sequence was performed in MD on 39 patients and in ES on other 39, of whom 26 patients met the criteria for PPVI. The latter was unsuccessful in ten patients (38%), mainly due (80% of cases) to significant size discrepancy at PV remnant and bifurcation levels (p = 0.019 and 0.037 respectively) between the measurements by 3D-SSFP in MD and those by the balloon size in systole. Significant RVOT size difference between MD and ES was present at mid-portion and bifurcation levels in the PVR candidate group, and at all three-levels in the control group (all p < 0.001). ES 3D-SSFP sequence is able to quantify RVOT dilation in rToF patients at its maximum expansion, thus improving selection of PPVI candidates.
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Affiliation(s)
- Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany
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14
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Hascoet S, Dalla Pozza R, Bentham J, Carere RG, Kanaan M, Ewert P, Biernacka EK, Kretschmar O, Deutsch C, Lecerf F, Lehner A, Kantzis M, Kurucova J, Thoenes M, Bramlage P, Haas NA. Early outcomes of percutaneous pulmonary valve implantation using the Edwards SAPIEN 3 transcatheter heart valve system. EUROINTERVENTION 2019; 14:1378-1385. [DOI: 10.4244/eij-d-18-01035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Magnetic resonance and computed tomography imaging fusion for live guidance of percutaneous pulmonary valve implantation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:413-421. [PMID: 30603031 PMCID: PMC6309845 DOI: 10.5114/aic.2018.79871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/18/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction Until recently, two-dimensional (2D) angiography was the mainstay of guidance for percutaneous pulmonary valve implantation (PPVI). Recent advances in fusion software have enabled direct fusion of pre-intervention imaging, magnetic resonance imaging (MRI) or computed tomography (CT) scans, to create a reliable three-dimensional (3D) roadmap for procedural guidance. Aim To report initial two-center experience with direct 2D–3D image fusion for live guidance of PPVI with MRI- and CT-derived 3D roadmaps. Material and methods We performed a prospective study on PPVIs guided with the new fusion imaging platform introduced in the last quarter of 2015. Results 3D guidance with an MRI- (n = 14) or CT- (n = 8) derived roadmap was utilized during 22 catheterizations for right ventricular outflow tract balloon sizing (n = 7) or PPVI (n = 15). Successful 2D–3D registration was performed in all but 1 patient. Six (27%) patients required intra-procedural readjustment of the 3D roadmap due to distortion of the anatomy after introduction of a stiff wire. Twenty-one (95%) interventions were successful in the application of 3D imaging. Patients in the CT group received less contrast volume and had a shorter procedural time, though the differences were not statistically significant. Those in the MRI group had significantly lower weight adjusted radiation exposure. Conclusions With intuitive segmentation and direct 2D–3D fusion of MRI or CT datasets, VesselNavigator facilitates PPVI. Our initial data show that utilization of CT-derived roadmaps may lead to less contrast exposure and shorter procedural time, whereas application of MRI datasets may lead to lower radiation exposure.
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Sinha S, Aboulhosn J, Asnes J, Bocks M, Zahn E, Goldstein BH, Zampi J, Hellenbrand W, Salem M, Levi D. Initial results from the off‐label use of the SAPIEN S3 valve for percutaneous transcatheter pulmonary valve replacement: A multi‐institutional experience. Catheter Cardiovasc Interv 2018; 93:455-463. [DOI: 10.1002/ccd.27973] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/15/2018] [Accepted: 10/19/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Sanjay Sinha
- Department of Pediatrics, Division of CardiologyUCLA Mattel Children's Hospital Los Angeles California
| | - Jamil Aboulhosn
- Department of Pediatrics, Division of CardiologyUCLA Mattel Children's Hospital Los Angeles California
- Department of MedicineAhmanson Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA Los Angeles California
| | - Jeremy Asnes
- Department of Pediatrics, Division of Cardiology, Yale Medical Center New Haven Connecticut
| | - Martin Bocks
- Department of Pediatrics, Division of Pediatric CardiologyUH Rainbow Babies and Children's Hospital Cleveland Ohio
| | - Evan Zahn
- Guerin Family Congenital Heart ProgramThe Heart Institute and Department of Pediatrics Cedars‐Sinai Medical Center Los Angeles California
| | - Bryan H. Goldstein
- Department of Pediatrics, Division of CardiologyCincinnati Children's Hospital Cincinnati Ohio
| | - Jeffrey Zampi
- Department of Pediatrics, Division of CardiologyUniversity of Michigan Ann Arbor Michigan
| | - William Hellenbrand
- Department of Pediatrics, Division of Cardiology, Yale Medical Center New Haven Connecticut
| | - Morris Salem
- Department of Pediatrics, Division of CardiologyKaiser Permanente Los Angeles California
| | - Daniel Levi
- Department of Pediatrics, Division of CardiologyUCLA Mattel Children's Hospital Los Angeles California
- Department of MedicineAhmanson Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA Los Angeles California
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17
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Jolley MA, Lasso A, Nam HH, Dinh PV, Scanlan AB, Nguyen AV, Ilina A, Morray B, Glatz AC, McGowan FX, Whitehead K, Dori Y, Gorman JH, Gorman RC, Fichtinger G, Gillespie MJ. Toward predictive modeling of catheter-based pulmonary valve replacement into native right ventricular outflow tracts. Catheter Cardiovasc Interv 2018; 93:E143-E152. [PMID: 30444053 DOI: 10.1002/ccd.27962] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/24/2018] [Accepted: 10/15/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pulmonary insufficiency is a consequence of transannular patch repair in Tetralogy of Fallot (ToF) leading to late morbidity and mortality. Transcatheter native outflow tract pulmonary valve replacement has become a reality. However, predicting a secure, atraumatic implantation of a catheter-based device remains a significant challenge due to the complex and dynamic nature of the right ventricular outflow tract (RVOT). We sought to quantify the differences in compression and volume for actual implants, and those predicted by pre-implant modeling. METHODS We used custom software to interactively place virtual transcatheter pulmonary valves (TPVs) into RVOT models created from pre-implant and post Harmony valve implant CT scans of 5 ovine surgical models of TOF to quantify and visualize device volume and compression. RESULTS Virtual device placement visually mimicked actual device placement and allowed for quantification of device volume and radius. On average, simulated proximal and distal device volumes and compression did not vary statistically throughout the cardiac cycle (P = 0.11) but assessment was limited by small sample size. In comparison to actual implants, there was no significant pairwise difference in the proximal third of the device (P > 0.80), but the simulated distal device volume was significantly underestimated relative to actual device implant volume (P = 0.06). CONCLUSIONS This study demonstrates that pre-implant modeling which assumes a rigid vessel wall may not accurately predict the degree of distal RVOT expansion following actual device placement. We suggest the potential for virtual modeling of TPVR to be a useful adjunct to procedural planning, but further development is needed.
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Affiliation(s)
- Matthew A Jolley
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andras Lasso
- Laboratory for Percutaneous Surgery, Queen's University, Kingston, Ontario
| | - Hannah H Nam
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Patrick V Dinh
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adam B Scanlan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alex V Nguyen
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anna Ilina
- Laboratory for Percutaneous Surgery, Queen's University, Kingston, Ontario
| | - Brian Morray
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington
| | - Andrew C Glatz
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Francis X McGowan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kevin Whitehead
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yoav Dori
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Gabor Fichtinger
- Laboratory for Percutaneous Surgery, Queen's University, Kingston, Ontario
| | - Matthew J Gillespie
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Gorman Cardiovascular Research Group, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Morgan GJ, Sadeghi S, Salem MM, Wilson N, Kay J, Rothman A, Galindo A, Martin MH, Gray R, Ross M, Aboulhosn JA, Levi DS. SAPIEN valve for percutaneous transcatheter pulmonary valve replacement without “pre‐stenting”: A multi‐institutional experience. Catheter Cardiovasc Interv 2018; 93:324-329. [DOI: 10.1002/ccd.27932] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/30/2018] [Accepted: 09/23/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Gareth J. Morgan
- Division of Pediatric CardiologyChildren's Hospital of Colorado Aurora Colorado
- Division of CardiologyUniversity of Colorado Aurora Colorado
| | - Soraya Sadeghi
- Department of Pediatrics, Division of CardiologyUCLA Mattel Children's Hospital Los Angeles California
| | - Moris M. Salem
- Department of Pediatrics, Division of CardiologyKaiser Permanente Los Angeles California
| | - Neil Wilson
- Division of Pediatric CardiologyChildren's Hospital of Colorado Aurora Colorado
| | - Joseph Kay
- Division of CardiologyUniversity of Colorado Aurora Colorado
| | - Abraham Rothman
- Division of Pediatric CardiologyChildren's Heart Center of Nevada Las Vegas Nevada
| | - Alvaro Galindo
- Division of Pediatric CardiologyChildren's Heart Center of Nevada Las Vegas Nevada
| | - Mary Hunt Martin
- Division of Pediatric CardiologyPrimary Children's Hospital Salt Lake City Utah
| | - Robert Gray
- Division of Pediatric CardiologyPrimary Children's Hospital Salt Lake City Utah
| | - Michael Ross
- Division of Pediatric CardiologyChildren's Hospital of Colorado Aurora Colorado
| | - Jamil A. Aboulhosn
- Department of Medicine, Ahmanson Adult Congenital Heart Disease CenterDavid Geffen School of Medicine at UCLA Los Angeles California
| | - Daniel Steven Levi
- Department of Pediatrics, Division of CardiologyUCLA Mattel Children's Hospital Los Angeles California
- Department of Medicine, Ahmanson Adult Congenital Heart Disease CenterDavid Geffen School of Medicine at UCLA Los Angeles California
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19
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Haas NA, Bach S, Vcasna R, Laser KT, Sandica E, Blanz U, Jakob A, Dietl M, Fischer M, Kanaan M, Lehner A. The risk of bacterial endocarditis after percutaneous and surgical biological pulmonary valve implantation. Int J Cardiol 2018; 268:55-60. [DOI: 10.1016/j.ijcard.2018.04.138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/30/2018] [Indexed: 02/04/2023]
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20
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Edwards SAPIEN Transcatheter Pulmonary Valve Implantation: Results From a French Registry. JACC Cardiovasc Interv 2018; 11:1909-1916. [PMID: 30219326 DOI: 10.1016/j.jcin.2018.05.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/14/2018] [Accepted: 05/22/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to describe and analyze data from patients treated in France with the Edwards SAPIEN transcatheter heart valve (Edwards Lifesciences LLC, Irvine, California) in the pulmonary position. BACKGROUND The Edwards SAPIEN valve has recently been introduced for percutaneous pulmonary valve implantation (PPVI). METHODS From April 2011 to May 2017, 71 patients undergoing PPVI were consecutively included. RESULTS The median age at PPVI was 26.8 years (range 12.8 to 70.1 years). Primary underlying diagnoses were conotruncal malformations (common arterial trunk, tetralogy of Fallot and variants; n = 45), Ross procedure (n = 18), and other diagnoses (n = 8). PPVI indication was pure stenosis in 33.8% of patients, pure regurgitation in 28.1%, and mixed lesions in 38.1%. PPVI was successfully implemented in 68 patients (95.8%). Pre-stenting of the right ventricular outflow tract was performed in 70 patients (98.6%). Early major complications occurred in 4 subjects (5.6%), including 1 death, 1 coronary compression, and 2 pulmonary valve embolizations. Three of the 4 major complications occurred in the first 15 operated patients. No significant regurgitation was recorded after the procedure. Transpulmonary gradient was significantly reduced from 34.5 to 10.5 mm Hg (p < 0.0001). No patient died during a 1-month follow-up period. At 1-year follow-up, the death rate was 2.9%, and 3 patients had undergone surgical reintervention (44%). CONCLUSIONS Early results with the Edwards SAPIEN valve in the pulmonary position demonstrate an ongoing high rate of procedural success.
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21
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Martin MH, Meadows J, McElhinney DB, Goldstein BH, Bergersen L, Qureshi AM, Shahanavaz S, Aboulhosn J, Berman D, Peng L, Gillespie M, Armstrong A, Weng C, Minich LL, Gray RG. Safety and Feasibility of Melody Transcatheter Pulmonary Valve Replacement in the Native Right Ventricular Outflow Tract. JACC Cardiovasc Interv 2018; 11:1642-1650. [DOI: 10.1016/j.jcin.2018.05.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/07/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
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22
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Kheiwa A, Divanji P, Mahadevan VS. Transcatheter pulmonary valve implantation: will it replace surgical pulmonary valve replacement? Expert Rev Cardiovasc Ther 2018; 16:197-207. [PMID: 29433351 DOI: 10.1080/14779072.2018.1435273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Right ventricular outflow tract (RVOT) dysfunction is a common hemodynamic challenge for adults with congenital heart disease (ACHD), including patients with repaired tetralogy of Fallot (TOF), truncus arteriosus (TA), and those who have undergone the Ross procedure for congenital aortic stenosis and the Rastelli repair for transposition of great vessels. Pulmonary valve replacement (PVR) has become one of the most common procedures performed for ACHD patients. Areas covered: Given the advances in transcatheter technology, we conducted a detailed review of the available studies addressing the indications for PVR, historical background, evolving technology, procedural aspects, and the future direction, with an emphasis on ACHD patients. Expert commentary: Transcatheter pulmonary valve implantation (TPVI) is widely accepted as an alternative to surgery to address RVOT dysfunction. However, current technology may not be able to adequately address a subset of patients with complex RVOT morphology. As the technology continues to evolve, new percutaneous valves will allow practitioners to apply the transcatheter approach in such patients. We expect that with the advancement in transcatheter technology, novel devices will be added to the TPVI armamentarium, making the transcatheter approach a feasible alternative for the majority of patients with RVOT dysfunction in the near future.
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Affiliation(s)
- Ahmed Kheiwa
- a Department of Medicine, Division of Cardiology , University of California San Francisco , San Francisco , CA , USA
| | - Punag Divanji
- a Department of Medicine, Division of Cardiology , University of California San Francisco , San Francisco , CA , USA
| | - Vaikom S Mahadevan
- a Department of Medicine, Division of Cardiology , University of California San Francisco , San Francisco , CA , USA.,b Adult Congenital Heart Disease Unit , Central Manchester University Hospitals, NHS Foundation Trust , Manchester , UK
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Haas NA, Carere RG, Kretschmar O, Horlick E, Rodés-Cabau J, de Wolf D, Gewillig M, Mullen M, Lehner A, Deutsch C, Bramlage P, Ewert P. Early outcomes of percutaneous pulmonary valve implantation using the Edwards SAPIEN XT transcatheter heart valve system. Int J Cardiol 2018; 250:86-91. [DOI: 10.1016/j.ijcard.2017.10.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/14/2017] [Accepted: 10/03/2017] [Indexed: 11/28/2022]
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24
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Simmons MA, Elder RW, Shabanova V, Hellenbrand W, Asnes J. Ventricular arrhythmias immediately following transcatheter pulmonary valve implantation: A cause for concern? Catheter Cardiovasc Interv 2017; 91:920-926. [DOI: 10.1002/ccd.27454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/27/2017] [Accepted: 12/04/2017] [Indexed: 11/08/2022]
Affiliation(s)
- M. Abigail Simmons
- Section of Pediatric Cardiology, Department of PediatricsYale University School of Medicine New Haven Connecticut
| | - Robert W. Elder
- Section of Pediatric Cardiology, Department of PediatricsYale University School of Medicine New Haven Connecticut
| | - Veronika Shabanova
- Department of PediatricsYale University School of MedicineNew Haven Connecticut
| | - William Hellenbrand
- Section of Pediatric Cardiology, Department of PediatricsYale University School of Medicine New Haven Connecticut
| | - Jeremy Asnes
- Section of Pediatric Cardiology, Department of PediatricsYale University School of Medicine New Haven Connecticut
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Malekzadeh-Milani S, Boudjemline Y. [The successful saga of percutaneous pulmonary valvulation in congenital heart diseases]. Presse Med 2017; 46:580-585. [PMID: 28549630 DOI: 10.1016/j.lpm.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 04/13/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022] Open
Abstract
With new surgical techniques, more and more complex congenital heart defects are treated requiring sometimes right ventricle to pulmonary artery conduit implantation. In order to extend RV to PA conduit lifespan, 15 years ago a valved stent was developed. The implantation technique was progressively standardized to decrease risks of procedural complications. Medium and long-term hemodynamic results of the stent were so good that indications were broadened to native or complex right ventricular outflow tracts. Currently, 2 types of stents are implanted routinely: the Melody valve® (Medtronic, Minneapolis, USA) and the Sapien® valve (Edwards, Lifesciences, Irvine, USA). Other devices are evaluated in trials: thanks to their diabolo shape, implantation is feasible in large outflows tracts. The main source of worries is infective endocarditis. Numerous studies are conducted in order to identify risks factors, prevention and optimal treatment of this complication. In the near future, new devices and new implantation strategies will make this technology available for a larger number of patients.
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Affiliation(s)
- Sophie Malekzadeh-Milani
- Assistance publique des Hôpitaux de Paris, centre de référence malformations cardiaques congénitales complexes-M3C, hôpital Necker-Enfants-Malades, hôpital européen Georges-Pompidou, 75015 Paris, France
| | - Younes Boudjemline
- Assistance publique des Hôpitaux de Paris, centre de référence malformations cardiaques congénitales complexes-M3C, hôpital Necker-Enfants-Malades, hôpital européen Georges-Pompidou, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France.
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Percutaneous pulmonary valve implantation - state of the art and Polish experience. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:3-9. [PMID: 28344611 PMCID: PMC5364276 DOI: 10.5114/aic.2017.66180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 01/11/2017] [Indexed: 11/25/2022] Open
Abstract
Percutaneous pulmonary valve implantation (PPVI) is a relatively new method of treating patients with right ventricular outflow tract (RVOT) dysfunction after surgical repair of congenital heart disease. Since its introduction in 2000 by Bonhoeffer, more than ten thousand PPVI procedures have been performed worldwide. Indications for PPVI have been adapted from those accepted for surgical intervention. Two types of valves are being used: Melody Medtronic available in diameters 16 mm and 18 mm and the family of Edwards SAPIEN valves 23, 26 and 29. The procedure has been shown to be feasible and safe when performed in patients with full pulmonary conduit dysfunction and in selected cases of patched RVOT. The low complication rate and the reduced number of open-chest re-interventions over a patient’s lifetime are among the main advantages of the procedure. The most important problem responsible for late mortality and reinterventions is infective endocarditis. Size restrictions of the currently available valves limit deployment in the majority of patients with a wide RVOT. Newer devices are being developed to make these patients suitable for PPVI. A literature review, Polish experience and results of PPVI performed in 66 patients in the Institute of Cardiology in Warsaw are briefly reported.
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Three-dimensional image fusion guidance of percutaneous pulmonary valve implantation to reduce radiation exposure and contrast dose: A comparison with traditional two-dimensional and three-dimensional rotational angiographic guidance. Neth Heart J 2016; 25:91-99. [PMID: 27966187 PMCID: PMC5260627 DOI: 10.1007/s12471-016-0941-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Three-dimensional rotational angiography (3DRA) has been used in the guidance of various transcatheter therapies including percutaneous pulmonary valve implantation (PPVI). The most recently available 3D image fusion software (VesselNavigator, Philips) extends this technology to use pre-registered computed tomography or magnetic resonance imaging datasets, promising reductions in contrast and radiation exposure along with shorter procedural times. METHODS In this retrospective review, patients were assigned to three groups according to the mode of imaging guidance: two-dimensional angiography (2DA), 3DRA and VesselNavigator (VN) assisted valve implantation. Patient characteristics and catheterisation data were reviewed with a focus on contrast and radiation exposure, fluoroscopy, and procedural times. RESULTS Between July 2012 and June 2016, 21 patients underwent PPVI: 8 with 2D guidance, 6 patients with 3DRA and most recently 7 patients with VN assistance. Patents in the VN group received significantly less absolute and weight indexed contrast when compared with those with 2DA or 3DRA guided PPVI. Patients in the 2DA group received a significantly higher total dose area product radiation dose and air kerma in comparison with patients with 3DRA and VN guided intervention. Application of VN resulted in the shortest fluoroscopy time, although not statistically significant, and a significantly shorter study time when compared with 2DA. CONCLUSIONS Utilisation of pre-intervention image manipulation with VesselNavigator for 3D guidance of PPVI results in a reduction in contrast and radiation exposure and study time as compared with traditional 2D guidance, and contrast usage as compared with 3DRA.
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Husain J, Praichasilchai P, Gilbert Y, Qureshi SA, Morgan GJ. Early European experience with the Venus P-valve®: filling the gap in percutaneous pulmonary valve implantation. EUROINTERVENTION 2016; 12:e643-51. [DOI: 10.4244/eijv12i5a105] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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29
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Levi DS, Sinha S, Salem MM, Aboulhosn JA. Transcatheter native pulmonary valve and tricuspid valve replacement with the sapien XT: Initial experience and development of a new delivery platform. Catheter Cardiovasc Interv 2016; 88:434-43. [DOI: 10.1002/ccd.26398] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel S. Levi
- Department of Pediatrics, Division of Cardiology; UCLA Mattel Children's Hospital; Los Angeles California
| | - Sanjay Sinha
- Department of Pediatrics, Division of Cardiology; UCLA Mattel Children's Hospital; Los Angeles California
| | - Morris M. Salem
- Department of Pediatrics, Division of Cardiology; Kaiser Permanente; Los Angeles California
| | - Jamil A. Aboulhosn
- Department of Medicine; Ahmanson Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA; Los Angeles California
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30
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Praz F, Windecker S, Huber C, Carrel T, Wenaweser P. Expanding Indications of Transcatheter Heart Valve Interventions. JACC Cardiovasc Interv 2015; 8:1777-96. [DOI: 10.1016/j.jcin.2015.08.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 01/10/2023]
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31
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Wagner R, Daehnert I, Lurz P. Percutaneous pulmonary and tricuspid valve implantations: An update. World J Cardiol 2015; 7:167-177. [PMID: 25914786 PMCID: PMC4404372 DOI: 10.4330/wjc.v7.i4.167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/08/2015] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology. Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status. Although techniques of percutaneous pulmonary valve implantation have been described just a decade ago, two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide. In contrast, percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status. Taking into account that an “interdisciplinary challenging”, heterogeneous population of patients previously treated by corrective, semi-corrective or palliative surgical procedures is growing inexorably, there is a rapidly increasing need of treatment options besides redo-surgery. Therefore, the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures, to update on current devices, to discuss indications and patient selection criteria, to report on clinical results and finally to consider future directions.
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Noorani A, Bapat V. Valve-in-Valve Therapy for Failed Surgical Bioprosthetic Valves: Clinical Results and Procedural Guidance. Interv Cardiol Clin 2015; 4:107-120. [PMID: 28582118 DOI: 10.1016/j.iccl.2014.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
With improved life expectancy and increased use of bioprosthetic heart valves, more elderly and frail patients present with degenerative surgical heart valve disease. The valve-in-valve procedure is an attractive alternative to a conventional open redo procedure. Although it is a novel extension of established transcatheter aortic valve implantation for severe aortic stenosis in a high-risk population, it is gaining momentum worldwide, particularly for aortic and mitral positions. Success depends on the operator being familiar with emerging transcatheter heart valve technology and morphology as well as that of the existing surgical heart valve, patient selection, accurate sizing, an ideal implantation position.
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Affiliation(s)
- Alia Noorani
- Department of Cardiothoracic Surgery, St Thomas' Hospital, 6th Floor, East Wing, London SE1 7EH, UK
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, St Thomas' Hospital, 6th Floor, East Wing, London SE1 7EH, UK.
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Kuetting M, Pott D, Sedaghat A, Ng YA, Egron S, Rosefort C, Werner N, Sachweh J, Steinseifer U. Right heart transcatheter valve therapies – a review of prostheses for the pulmonary and tricuspid positions. Expert Rev Med Devices 2014; 12:163-74. [DOI: 10.1586/17434440.2015.985654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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