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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.
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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
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2
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Satawiriya M, Chandavimol M, Limsuwan A. Melody transcatheter pulmonary valve replacement: a single-center case series in Southeast Asia. BMC Cardiovasc Disord 2024; 24:301. [PMID: 38872098 PMCID: PMC11170848 DOI: 10.1186/s12872-024-03919-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/02/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Studies of transcatheter pulmonary valve replacement (TPVR) with the Melody valve have demonstrated good clinical and hemodynamic outcomes. Our study analyzes the midterm clinical and hemodynamic outcomes for patients who underwent Melody valve implantation in Southeast Asia. METHODS Patients with circumferential conduits or bioprosthetic valves and experiencing post-operative right ventricular outflow tract (RVOT) dysfunction were recruited for Melody TPVR. RESULTS Our cohort (n = 14) was evenly divided between pediatric and adult patients. The median age was 19 years (8-38 years), a male-to-female ratio of 6:1 with a median follow-up period of 48 months (16-79 months), and the smallest patient was an 8-year-old boy weighing 18 kg. All TPVR procedures were uneventful and successful with no immediate mortality or conduit rupture. The primary implant indication was combined stenosis and regurgitation. The average conduit diameter was 21 ± 2.3 mm. Concomitant pre-stenting was done in 71.4% of the patients without Melody valve stent fractures (MSFs). Implanted valve size included 22-mm (64.3%), 20-mm (14.3%), and 18-mm (21.4%). After TPVR, the mean gradient across the RVOT was significantly reduced from 41 mmHg (10-48 mmHg) to 16 mmHg (6-35 mmHg) at discharge, p < 0.01. Late follow-up infective endocarditis (IE) was diagnosed in 2 patients (14.3%). Overall freedom from IE was 86% at 79 months follow-up. Three patients (21.4%) developed progressive RVOT gradients. CONCLUSION For patients in Southeast Asia with RVOT dysfunction, Melody TPVR outcomes are similar to those reported for patients in the US in terms of hemodynamic and clinical improvements. A pre-stenting strategy was adopted and no MSFs were observed. Post-implantation residual stenosis and progressive stenosis of the RVOT require long term monitoring and reintervention. Lastly, IE remained a concern despite vigorous prevention and peri-procedural bacterial endocarditis prophylaxis.
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Affiliation(s)
- Marin Satawiriya
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Rd, Rachathewi, Bangkok, 10400, Thailand
| | - Mann Chandavimol
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Alisa Limsuwan
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Rd, Rachathewi, Bangkok, 10400, Thailand.
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Goldstein BH, McElhinney DB, Gillespie MJ, Aboulhosn JA, Levi DS, Morray BH, Cabalka AK, Love BA, Zampi JD, Balzer DT, Law MA, Schiff MD, Hoskoppal A, Qureshi AM. Early Outcomes From a Multicenter Transcatheter Self-Expanding Pulmonary Valve Replacement Registry. J Am Coll Cardiol 2024; 83:1310-1321. [PMID: 38569760 DOI: 10.1016/j.jacc.2024.02.010] [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: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Transcatheter pulmonary valve replacement (TPVR) with the self-expanding Harmony valve (Medtronic) is an emerging treatment for patients with native or surgically repaired right ventricular outflow tract (RVOT) pulmonary regurgitation (PR). Limited data are available since U.S. Food and Drug Administration approval in 2021. OBJECTIVES In this study, the authors sought to evaluate the safety and short-term effectiveness of self-expanding TPVR in a real-world experience. METHODS This was a multicenter registry study of consecutive patients with native RVOT PR who underwent TPVR through April 30, 2022, at 11 U.S. CENTERS The primary outcome was a composite of hemodynamic dysfunction (PR greater than mild and RVOT mean gradient >30 mm Hg) and RVOT reintervention. RESULTS A total of 243 patients underwent TPVR at a median age of 31 years (Q1-Q3: 19-45 years). Cardiac diagnoses were tetralogy of Fallot (71%), valvular pulmonary stenosis (21%), and other (8%). Acute technical success was achieved in all but 1 case. Procedural serious adverse events occurred in 4% of cases, with no device embolization or death. Hospital length of stay was 1 day in 86% of patients. Ventricular arrhythmia prompting treatment occurred in 19% of cases. At a median follow-up of 13 months (Q1-Q3: 8-19 months), 98% of patients had acceptable hemodynamic function. Estimated freedom from the composite clinical outcome was 99% at 1 year and 96% at 2 years. Freedom from TPVR-related endocarditis was 98% at 1 year. Five patients died from COVID-19 (n = 1), unknown causes (n = 2), and bloodstream infection (n = 2). CONCLUSIONS In this large multicenter real-world experience, short-term clinical and hemodynamic outcomes of self-expanding TPVR therapy were excellent. Ongoing follow-up of this cohort will provide important insights into long-term outcomes.
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Affiliation(s)
- Bryan H Goldstein
- Division of Pediatric Cardiology, University of Pittsburgh School of Medicine and Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Doff B McElhinney
- Departments of Cardiothoracic Surgery and Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
| | - Matthew J Gillespie
- Division of Pediatric Cardiology, University of Pennsylvania School of Medicine and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jamil A Aboulhosn
- Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | - Daniel S Levi
- Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | - Brian H Morray
- Department of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Allison K Cabalka
- Divisions of Pediatric Cardiology and Structural Heart Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Barry A Love
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey D Zampi
- Department of Pediatrics, University of Michigan Congenital Heart Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - David T Balzer
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Mark A Law
- Department of Pediatrics, University of Alabama, Birmingham, Alabama, USA
| | - Mary D Schiff
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Arvind Hoskoppal
- Division of Pediatric Cardiology, University of Pittsburgh School of Medicine and Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Athar M Qureshi
- Section of Cardiology, Texas Children's Hospital, Houston, Texas, USA
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Park WY, Kim GB, Lee SY, Kim AY, Choi JY, Jang SI, Kim SH, Cha SG, Wang JK, Lin MT, Chen CA. The adaptability of the Pulsta valve to the diverse main pulmonary artery shape of native right ventricular outflow tract disease. Catheter Cardiovasc Interv 2024; 103:587-596. [PMID: 38341624 DOI: 10.1002/ccd.30968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Pulsta valve is increasingly used for percutaneous pulmonary valve implantation (PPVI) in patients with a large native right ventricular outflow tract (RVOT). This study aims to elucidate the outcomes of Pulsta valve implantation within the native RVOT and assess its adaptability to various native main pulmonary artery (PA) anatomies. METHODS A multicenter retrospective study included 182 patients with moderate to severe pulmonary regurgitation in the native RVOT who underwent PPVI with Pulsta valves® between February 2016 and August 2023 at five Korean and Taiwanese tertiary referral centers. RESULTS Pulsta valve implantation was successful in 179 out of 182 patients (98.4%) with an average age of 26.7 ± 11.0 years. The median follow-up duration was 29 months. Baseline assessments revealed enlarged right ventricle (RV) volume (mean indexed RV end-diastolic volume: 163.1 (interquartile range, IQR: 152.0-180.3 mL/m²), which significantly decreased to 123.6(IQR: 106.6-137.5 mL/m2 after 1 year. The main PA types were classified as pyramidal (3.8%), straight (38.5%), reverse pyramidal (13.2%), convex (26.4%), and concave (18.1%) shapes. Pulsta valve placement was adapted, with distal main PA for pyramidal shapes and proximal or mid-PA for reverse pyramidal shapes. Two patients experienced Pulsta valve embolization to RV, requiring surgical removal, and one patient encountered valve migration to the distal main PA, necessitating surgical fixation. CONCLUSIONS Customized valve insertion sites are pivotal in self-expandable PPVI considering diverse native RVOT shape. The rather soft and compact structure of the Pulsta valve has characteristics to are adaptable to diverse native RVOT geometries.
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Affiliation(s)
- Woo Young Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ah Young Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Young Choi
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Ick Jang
- Department of Pediatrics, Sejong General Hospital, Bucheon, Republic of Korea
| | - Seong Ho Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Republic of Korea
| | - Seul Gi Cha
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
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Pan W, Zhou D, Hijazi ZM, Qureshi SA, Promphan W, Feng Y, Zhang G, Liu X, Pan X, Chen L, Cao Q, Tiong KG, Leong MC, Roymanee S, Prachasilchai P, Choi JY, Tomita H, Le Tan J, Akhtar K, Lam S, So K, Tin DN, Nguyen LH, Huo Y, Wang J, Ge J. 2024 Statement from Asia expert operators on transcatheter pulmonary valve replacement. Catheter Cardiovasc Interv 2024; 103:660-669. [PMID: 38419402 DOI: 10.1002/ccd.30978] [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: 09/14/2023] [Revised: 11/13/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
Transcatheter pulmonary valve replacement (TPVR), also known as percutaneous pulmonary valve implantation, refers to a minimally invasive technique that replaces the pulmonary valve by delivering an artificial pulmonary prosthesis through a catheter into the diseased pulmonary valve under the guidance of X-ray and/or echocardiogram while the heart is still beating not arrested. In recent years, TPVR has achieved remarkable progress in device development, evidence-based medicine proof and clinical experience. To update the knowledge of TPVR in a timely fashion, and according to the latest research and further facilitate the standardized and healthy development of TPVR in Asia, we have updated this consensus statement. After systematical review of the relevant literature with an in-depth analysis of eight main issues, we finally established eight core viewpoints, including indication recommendation, device selection, perioperative evaluation, procedure precautions, and prevention and treatment of complications.
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Affiliation(s)
- Wenzhi Pan
- Zhongshan Hopital, Fudan University, Shanghai, China
| | - Daxin Zhou
- Zhongshan Hopital, Fudan University, Shanghai, China
| | - Ziyad M Hijazi
- Pediatrics & Medicine, Weill Cornell Medicine, Doha, Qatar
| | | | - Worakan Promphan
- Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Yuan Feng
- West China Hospital, Sichuan University, Chengdu, China
| | | | - Xianbao Liu
- Second Hospital of Zhejiang Medical University, Hangzhou, China
| | - Xin Pan
- Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | | | | | | | | | | | - Pimpak Prachasilchai
- Queen Sirikit National Institute of Child Health, Pediatric Cardiac Center, Thailand
| | | | | | - Ju Le Tan
- National Heart Center, Singapore, Singapore
| | - Khurram Akhtar
- Armed Forces Institute of Cardiology National Institute of Heart Diseases, Rawalpindi, Pakistan
| | - Simon Lam
- Queen Marry Hospital, Hong Kong, China
| | - Kent So
- The Chinese University of Hong Kong, Hong Kong, China
| | - Do N Tin
- Children's Hospital, Hanoi, Vietnam
| | | | - Yong Huo
- Peking University First Hospital, Beijing, China
| | - Jian'an Wang
- Second Hospital of Zhejiang Medical University, Hangzhou, China
| | - Junbo Ge
- Zhongshan Hopital, Fudan University, Shanghai, China
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Stefanescu Schmidt AC, Armstrong AK, Aboulhosn JA, Kennedy KF, Jones TK, Levi DS, McElhinney DB, Bhatt AB. Transcatheter Pulmonary Valve Replacement With Balloon-Expandable Valves: Utilization and Procedural Outcomes From the IMPACT Registry. JACC Cardiovasc Interv 2024; 17:231-244. [PMID: 38267137 DOI: 10.1016/j.jcin.2023.10.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/03/2023] [Accepted: 10/31/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Transcatheter pulmonary valve replacement (TPVR) has expanded and evolved since its initial commercial approval in the United States in 2010. OBJECTIVES This study sought to characterize real-world practice, including patient selection, procedural outcomes, complications, and off-label usage. METHODS Characteristics and outcomes for patients undergoing balloon-expandable TPVR were collected from the American College of Cardiology National Cardiovascular Data Registry IMPACT (Improving Pediatric and Adult Congenital Treatment) Registry. RESULTS Between April 2016 and March 2021, 4,513 TPVR procedures were performed in patients with a median age of 19 years, 57% with a Melody (Medtronic Inc) and 43% with a SAPIEN (Edwards Lifesciences) valve. Most implanting centers performed <10 cases annually. One-third of transcatheter pulmonary valve implants were into homograft conduits, one-third were into bioprosthetic valves (BPVs), 25% were in native or patched right ventricular outflow tracts (RVOTs), and 6% were into Contegra (Medtronic Inc) conduits. Over the course of the study period, SAPIEN valve use grew from ∼25% to 60%, in large part because of implants in patients with a native/patched RVOT. Acute success was achieved in 95% of patients (95.7% in homografts, 96.2% in BPVs, 94.2% in native RVOTs, and 95.4% in Contegra conduits). Major adverse events occurred in 2.4% of procedures, more commonly in patients with a homograft (2.9%) or native RVOT (3.4%) than a prior BPV (1.4%; P = 0.004). CONCLUSIONS This study describes novel population data on the use and procedural outcomes of TPVR with balloon-expandable valves. Over time, there has been increasing use of TPVR to treat regurgitant native RVOT anatomy, with the SAPIEN valve more commonly used for this application.
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Affiliation(s)
- Ada C Stefanescu Schmidt
- Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | | | - Jamil A Aboulhosn
- Ahmanson/University of California, Los Angeles Adult Congenital Heart Center, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA
| | | | - Thomas K Jones
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Daniel S Levi
- Mattel Children's Hospital at University of California-Los Angeles, Los Angeles, California, USA
| | | | - Ami B Bhatt
- Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; American College of Cardiology, Washington, DC, USA
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JACC Cardiovasc Interv 2024; 17:115-216. [PMID: 38099915 DOI: 10.1016/j.jcin.2023.11.001] [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] [Indexed: 01/26/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California.
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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Han BK, Garcia S, Aboulhosn J, Blanke P, Martin MH, Zahn E, Crean A, Overman D, Craig CH, Hanneman K, Semple T, Armstrong A. Technical recommendations for computed tomography guidance of intervention in the right ventricular outflow tract: Native RVOT, conduits and bioprosthetic valves:: A white paper of the Society of Cardiovascular Computed Tomography (SCCT), Congenital Heart Surgeons' Society (CHSS), and Society for Cardiovascular Angiography & Interventions (SCAI). J Cardiovasc Comput Tomogr 2024; 18:75-99. [PMID: 37517984 DOI: 10.1016/j.jcct.2023.06.005] [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: 11/21/2022] [Revised: 05/03/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023]
Abstract
This consensus document for the performance of Cardiovascular Computed Tomography (CCT) to guide intervention in the right ventricular outflow tract (RVOT) in patients with congenital disease (CHD) was developed collaboratively by pediatric and adult interventionalists, surgeons and cardiac imagers with expertise specific to this patient subset. The document summarizes definitions of RVOT dysfunction as assessed by multi-modality imaging techniques and reviews existing consensus statements and guideline documents pertaining to indications for intervention. In the context of this background information, recommendations for CCT scan acquisition and a standardized approach for reporting prior to surgical or transcatheter pulmonary valve replacement are proposed and presented. It is the first Imaging for Intervention collaboration for CHD patients and encompasses imaging and reporting recommendations prior to both surgical and percutaneous pulmonary valve replacement.
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Affiliation(s)
- B Kelly Han
- University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA.
| | - Santiago Garcia
- The Carl and Edyth Lindner Center for Research and Education and the Christ Hospital, Cincinnati, Ohio, USA
| | - Jamil Aboulhosn
- University of California Los Angeles (UCLA) Health, Los Angeles, California, USA
| | - Phillip Blanke
- St. Paul's Hospital & University of British Columbia, Vancouver, Canada
| | - Mary Hunt Martin
- University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Evan Zahn
- Cedars-Sinai, Smidt Heart Institute, Los Angeles, California, USA
| | - Andrew Crean
- University of Ottawa Heart Institute, Ottawa, Canada
| | - David Overman
- The Children's Heart Clinic, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minnesota, USA
| | - C Hamilton Craig
- University of Queensland and Griffith University, Queensland, New Zealand
| | | | - Thomas Semple
- The Royal Brompton Hospital, London, England, United Kingdom
| | - Aimee Armstrong
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Boucek DM, Qureshi AM, Aggarwal V, Spigel ZA, Johnson J, Gray RG, Martin MH. Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement. Cardiol Young 2023; 33:2282-2290. [PMID: 36705001 DOI: 10.1017/s104795112200405x] [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] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine the safety and feasibility of over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement. BACKGROUND Transcatheter pulmonary valve placement is an alternative to surgical pulmonary valve replacement. Traditionally, it was thought to be unsafe to expand a conduit to >110% of its original size. METHODS This retrospective cohort study from two centers includes patients with right ventricle to pulmonary artery conduits with attempted transcatheter pulmonary valve placement from 2010 to 2017. Demographic, procedural, echocardiographic and follow-up data, and complications were evaluated in control and overdilation (to >110% original conduit size) groups. RESULTS One hundred and seventy-two patients (51 overdilation and 121 control) had attempted transcatheter pulmonary valve placement (98% successful). The overdilation group was younger (11.2 versus 16.7 years, p < 0.001) with smaller conduits (15 versus 22 mm, p < 0.001); however, the final valve size was not significantly different (19.7 versus 20.2 mm, p = 0.2). Baseline peak echocardiographic gradient was no different (51.8 versus 55.6 mmHg, p = 0.3). Procedural complications were more frequent in overdilation (18%) than control (7%) groups (most successfully addressed during the procedure). One patient from each group required urgent surgical intervention, with no procedural mortality. Follow-up echocardiographic peak gradients were similar (24.1 versus 26 mmHg, p = 0.5). CONCLUSIONS Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement can be performed successfully. Procedural complications are more frequent with conduit overdilation, but there was no difference in the rate of life-threatening complications. There was no difference in valve function at most recent follow-up, and no difference in rate of reintervention. The long-term outcomes of transcatheter pulmonary valve placement with conduit over-expansion requires further study.
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Affiliation(s)
- Dana M Boucek
- Department of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Masonic Children's Hospital, Minneapolis, MN, USA
| | - Zachary A Spigel
- Department of Surgery, Allegheny Health Network Medical Education Consortium, Pittsburgh, PA, USA
| | - Joyce Johnson
- Department of Pediatric Cardiology, John's Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Robert G Gray
- Department of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mary Hunt Martin
- Department of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
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10
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Han BK, Garcia S, Aboulhosn J, Blanke P, Martin MH, Zahn E, Crean A, Overman D, Hamilton Craig C, Hanneman K, Semple T, Armstrong A. Technical Recommendations for Computed Tomography Guidance of Intervention in the Right Ventricular Outflow Tract: Native RVOT, Conduits, and Bioprosthetic Valves. World J Pediatr Congenit Heart Surg 2023; 14:761-791. [PMID: 37647270 PMCID: PMC10685707 DOI: 10.1177/21501351231186898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
This consensus document for the performance of cardiovascular computed tomography (CCT) to guide intervention in the right ventricular outflow tract (RVOT) in patients with congenital heart disease (CHD) was developed collaboratively by pediatric and adult interventionalists, surgeons, and cardiac imagers with expertise specific to this patient subset. The document summarizes definitions of RVOT dysfunction as assessed by multimodality imaging techniques and reviews existing consensus statements and guideline documents pertaining to indications for intervention. In the context of this background information, recommendations for CCT scan acquisition and a standardized approach for reporting prior to surgical or transcatheter pulmonary valve replacement are proposed and presented. It is the first Imaging for Intervention collaboration for CHD patients and encompasses imaging and reporting recommendations prior to both surgical and percutaneous pulmonary valve replacement.
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Affiliation(s)
- B. Kelly Han
- University of Utah, Intermountain Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Santiago Garcia
- The Carl and Edyth Lindner Center for Research and Education and The Christ Hospital, Cincinnati, OH, USA
| | - Jamil Aboulhosn
- University of California Los Angeles (UCLA) Health, Los Angeles, CA, USA
| | - Phillip Blanke
- St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Hunt Martin
- University of Utah, Intermountain Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Evan Zahn
- Cedars-Sinai, Smidt Heart Institute, Los Angeles, CA, USA
| | - Andrew Crean
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David Overman
- The Children’s Heart Clinic, Children’s Minnesota, Mayo Clinic-Children’s Minnesota Cardiovascular Collaborative, Minneapolis, MN, USA
| | - C. Hamilton Craig
- University of Queensland and Griffith University, Queensland, Australia
| | | | | | - Aimee Armstrong
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
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11
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Ewert P. The Harmony Valve: A Success Story: Not Only for the Valve! JACC Cardiovasc Interv 2023; 16:1929-1930. [PMID: 37204398 DOI: 10.1016/j.jcin.2023.04.007] [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: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Peter Ewert
- German Heart Center Munich, Munich, Germany.
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12
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Crago M, Winlaw DS, Farajikhah S, Dehghani F, Naficy S. Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies. Bioeng Transl Med 2023; 8:e10501. [PMID: 37476058 PMCID: PMC10354783 DOI: 10.1002/btm2.10501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 03/06/2023] Open
Abstract
Congenital heart diseases (CHDs) frequently impact the right ventricular outflow tract, resulting in a significant incidence of pulmonary valve replacement in the pediatric population. While contemporary pediatric pulmonary valve replacements (PPVRs) allow satisfactory patient survival, their biocompatibility and durability remain suboptimal and repeat operations are commonplace, especially for very young patients. This places enormous physical, financial, and psychological burdens on patients and their parents, highlighting an urgent clinical need for better PPVRs. An important reason for the clinical failure of PPVRs is biofouling, which instigates various adverse biological responses such as thrombosis and infection, promoting research into various antifouling chemistries that may find utility in PPVR materials. Another significant contributor is the inevitability of somatic growth in pediatric patients, causing structural discrepancies between the patient and PPVR, stimulating the development of various growth-accommodating heart valve prototypes. This review offers an interdisciplinary perspective on these challenges by exploring clinical experiences, physiological understandings, and bioengineering technologies that may contribute to device development. It thus aims to provide an insight into the design requirements of next-generation PPVRs to advance clinical outcomes and promote patient quality of life.
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Affiliation(s)
- Matthew Crago
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
| | - David S. Winlaw
- Department of Cardiothoracic SurgeryHeart Institute, Cincinnati Children's HospitalCincinnatiOHUSA
| | - Syamak Farajikhah
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
| | - Fariba Dehghani
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
| | - Sina Naficy
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
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13
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Marchini F, Meossi S, Passarini G, Campo G, Pavasini R. Pulmonary Valve Stenosis: From Diagnosis to Current Management Techniques and Future Prospects. Vasc Health Risk Manag 2023; 19:379-390. [PMID: 37416511 PMCID: PMC10320808 DOI: 10.2147/vhrm.s380240] [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: 03/28/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
Pulmonary stenosis (PS) is mainly a congenital defect that accounts for 7-12% of congenital heart diseases (CHD). It can be isolated or, more frequently, associated with other congenital defects (25-30%) involving anomalies of the pulmonary vascular tree. For the diagnosis of PS an integrated approach with echocardiography, cardiac computed tomography and cardiac magnetic resonance (CMR) is of paramount importance for the planning of the interventional treatment. In recent years, transcatheter approaches for the treatment of PS have increased however, meaning surgery is a possible option for complicated cases with anatomy not suitable for percutaneous treatment. The present review aims to summarize current knowledge regarding diagnosis and treatment of PS.
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Affiliation(s)
- Federico Marchini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Sofia Meossi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Giulia Passarini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
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14
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El-Said H, Hussein A, Ganta S, Ryan J, Nigro J. Surgical Mitral Valve Replacement Using a Catheter-Based Melody TM Valve in a Landing Zone Constructed With a PTFE-Covered Expandable Cheatham-Platinum TM Stent. World J Pediatr Congenit Heart Surg 2023; 14:368-370. [PMID: 36872629 DOI: 10.1177/21501351231154213] [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: 03/07/2023]
Abstract
Mitral valve replacement using a Melody valve is a promising solution to the challenge of surgical mitral valve replacement in infants with a hypoplastic annulus. We report the creation of a landing zone in the mitral valve annulus using a Cheatham-Platinum (CP)-covered stent that facilitates Melody valve placement, helps prevent paravalvular leak, minimizes left ventricular outflow tract obstruction, and allows for potential future dilation of the valve.
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Affiliation(s)
- Howaida El-Said
- Division of Pediatric Cardiology, University of California San Diego and 14444Rady Children's Hospital, San Diego, CA, USA
| | - Amira Hussein
- Division of Pediatric Cardiology, University of California San Diego and 14444Rady Children's Hospital, San Diego, CA, USA
| | - Srujan Ganta
- Division of Cardiothoracic Surgery, 14444Rady Children's Hospital, San Diego, CA, USA
| | - Justin Ryan
- Webster Foundation 3D Innovations Lab, 14444Rady Children's Hospital, San Diego, CA, USA.,Department of Neurological Surgery, 14444Rady Children's Hospital, UC San Diego, San Diego, CA, USA
| | - John Nigro
- Division of Cardiothoracic Surgery, 14444Rady Children's Hospital, San Diego, CA, USA.,Division Cardiovascular and Thoracic Surgery, 14444University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
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15
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Constantine A, Dimopoulos K, Heng EL, Kempny A. Transcatheter pulmonary valve implantation: An option for the few becoming an option for the many. Int J Cardiol 2023; 373:44-46. [PMID: 36529307 DOI: 10.1016/j.ijcard.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, United Kingdom.
| | - Ee Ling Heng
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Aleksander Kempny
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, United Kingdom
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16
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Bou-Chaaya RG, Zhu Z, Duarte VE, Lin CH. Percutaneous Structural Interventions in Adult Congenital Heart Disease: State-of-the-Art Review. Methodist Debakey Cardiovasc J 2023; 19:78-90. [PMID: 37213883 PMCID: PMC10198245 DOI: 10.14797/mdcvj.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023] Open
Abstract
Structural interventions play a crucial role in the management of adult congenital heart disease (ACHD). In recent years, this field has seen significant advancements in catheter-based procedures despite limited investment from industry and lack of device development specific to this population. Because each patient is unique in their anatomy, pathophysiology, and surgical repair, many devices are used off-label with a "best fit" strategy. Therefore, continuous innovation is needed to adapt what is available to ACHD and to increase collaboration with industry and regulatory bodies to develop dedicated equipment. These innovations will further advance the field and offer this growing population less invasive options with fewer complications and faster recovery times. In this article, we summarize some of the contemporary structural interventions performed in adults with congenital defects and present cases performed at Houston Methodist to better illustrate them. We aim to offer a greater understanding of the field and stimulate interest in this rapidly growing specialty.
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Affiliation(s)
- Rody G. Bou-Chaaya
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
- *Rody G. Bou Chaaya and Zhihao Zhu contributed equally
| | - Zhihao Zhu
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
- *Rody G. Bou Chaaya and Zhihao Zhu contributed equally
| | - Valeria E. Duarte
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Chun Huie Lin
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
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17
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Cools B, Nagaraju CK, Vandendriessche K, van Puyvelde J, Youness M, Roderick HL, Gewillig M, Sipido K, Claus P, Rega F. Reversal of Right Ventricular Remodeling After Correction of Pulmonary Regurgitation in Tetralogy of Fallot. JACC Basic Transl Sci 2022; 8:301-315. [PMID: 37034286 PMCID: PMC10077151 DOI: 10.1016/j.jacbts.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 12/15/2022]
Abstract
In the sheep model with pathophysiologic changes similar to patients with repaired TOF, severe PR leads to fibrotic changes in the RV. Pulmonary valve replacement reverses these fibrotic changes. Early valve replacement led to a quick RV recovery, and in time there was no difference in outcome between early and late valve replacement. These data support the benefit of valve replacement for RV function and suggest that there is a margin in the timing of the surgery. The fibrotic changes correlated well with the circulating biomarker PICP, which can have an added value in the clinical follow-up of patients with repaired TOF.
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Affiliation(s)
- Bjorn Cools
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | | | - Joeri van Puyvelde
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Mohamad Youness
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Marc Gewillig
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Karin Sipido
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
- Address for correspondence: Dr Filip Rega, Department of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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18
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Current status of adult cardiac surgery-Part 1. Curr Probl Surg 2022; 59:101246. [PMID: 36496252 DOI: 10.1016/j.cpsurg.2022.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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19
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Lawley CM, Tanous D, O'Donnell C, Anderson B, Aroney N, Walters DL, Shipton S, Wilson W, Celermajer DS, Roberts P. Ten Years of Percutaneous Pulmonary Valve Implantation in Australia and New Zealand. Heart Lung Circ 2022; 31:1649-1657. [PMID: 36038469 DOI: 10.1016/j.hlc.2022.07.008] [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: 06/17/2021] [Revised: 04/28/2022] [Accepted: 07/12/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study sought to investigate the characteristics, morbidity (including the rate of infective endocarditis and valve replacement) and mortality of individuals undergoing percutaneous pulmonary valve implantation in Australia and New Zealand since the procedure has been performed. BACKGROUND The outcomes of percutaneous pulmonary valve implantation in Australia and New Zealand have not been evaluated. Recent international data, including patients from New Zealand, suggests the rate of infective endocarditis is not insignificant. METHODS A retrospective multi-site cohort study was undertaken via medical record review at the centres where percutaneous pulmonary valve implantation has been performed. All procedures performed from 2009-March 2018 were included. Individuals were identified from local institution databases. Data was collected and analysed including demographics, details at the time of intervention, haemodynamic outcome, post procedure morbidity and mortality. Multi-site ethics approval was obtained. RESULTS One hundred and seventy-nine (179) patients attended the cardiac catheter laboratory for planned percutaneous pulmonary valve implantation. Of these patients, 172 underwent successful implantation. Tetralogy of Fallot and pulmonary atresia were the most common diagnoses. The median age at procedure was 19 years (range 3-60 yrs). There was a significant improvement in the acute haemodynamics in patients undergoing percutaneous pulmonary valve implantation for stenosis. Seven (7) patients (3.9%) experienced a major procedural/early post procedure complication (death, conversion to open procedure, cardiac arrest), including two deaths. The annualised rates of infective endocarditis and valve replacement were 4.6% and 3.8% respectively. There was one death related to infective endocarditis in follow-up. CONCLUSIONS Percutaneous pulmonary valve replacement is a relatively safe method of rehabilitating the right ventricular outflow tract.
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Affiliation(s)
- Claire M Lawley
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - David Tanous
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Clare O'Donnell
- Green Lane Paediatric and Congenital Cardiac Service, Starship/Auckland City Hospitals, Starship Children's Hospital, Auckland, New Zealand
| | - Benjamin Anderson
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Qld, Australia
| | - Nicholas Aroney
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Darren L Walters
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; The University of Queensland, Brisbane, Qld, Australia
| | - Stephen Shipton
- Children's Cardiac Centre, Perth Children's Hospital, Perth, WA, Australia
| | - William Wilson
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Philip Roberts
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia
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20
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First experiences with Myval Transcatheter Heart Valve System in the treatment of severe pulmonary regurgitation in native right ventricular outflow tract and conduit dysfunction. Cardiol Young 2022; 32:1609-1615. [PMID: 34889176 DOI: 10.1017/s1047951121004650] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The rate of morbidity and mortality related to pulmonary regurgitation and pulmonary stenosis are big concerns after the surgery for CHD. Percutaneous pulmonary valve implantation has been established as a less invasive technique compared to surgery with promising results according to long-term follow-up of the patients. There are only two approved valve options for percutaneous pulmonary valve implantation until now, which are Melody (Medtronic, Minneapolis, Minn, USA) and Sapien (Edwards Lifesciences, Irvine, Ca, USA). Both valves have limitations and do not cover entire patient population. Therefore, the cardiologists need more options to improve outcomes with fewer complications in a such promising area. Herein, we present a case series applying for pulmonary position in conduits and native right ventricular outflow tract of a new transcatheter valve system Myval ® which is designed for transcatheter aortic valve implantation procedures. This is the first patient series in which the use of Myvalv in dysfunctional right ventricular outflow tracts is described, after surgical repair of CHD.
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21
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Pugliese L, Ricci F, Luciano A, De Stasio V, Presicce M, Spiritigliozzi L, Di Tosto F, Di Donna C, D'Errico F, Benelli L, Pasqualetto M, Grimaldi F, Mecchia D, Sbordone P, Cesareni M, Cerimele C, Cerocchi M, Laudazi M, Leomanni P, Rellini C, Dell'Olio V, Patanè A, Romeo F, Barillà F, Garaci F, Floris R, Chiocchi M. Role of computed tomography in transcatheter replacement of 'other valves': a comprehensive review of preprocedural imaging. J Cardiovasc Med (Hagerstown) 2022; 23:575-588. [PMID: 35994705 DOI: 10.2459/jcm.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transcatheter procedures for heart valve repair or replacement represent a valid alternative for treating patients who are inoperable or at a high risk for open-heart surgery. The transcatheter approach has become predominant over surgical intervention for aortic valve disease, but it is also increasingly utilized for diseases of the 'other valves', that is the mitral and, to a lesser extent, tricuspid and pulmonary valve. Preprocedural imaging is essential for planning the transcatheter intervention and computed tomography has become the main imaging modality by providing information that can guide the type of treatment and choice of device as well as predict outcome and prevent complications. In particular, preprocedural computed tomography is useful for providing anatomic details and simulating the effects of device implantation using 3D models. Transcatheter mitral valve replacement is indicated for the treatment of mitral regurgitation, either primary or secondary, and computed tomography is crucial for the success of the procedure. It allows evaluating the mitral valve apparatus, the surrounding structures and the left heart chambers, identifying the best access route and the landing zone and myocardial shelf, and predicting obstruction of the left ventricular outflow tract, which is the most frequent postprocedural complication. Tricuspid valve regurgitation with or without stenosis and pulmonary valve stenosis and regurgitation can also be treated using a transcatheter approach. Computer tomography provides information on the tricuspid and pulmonary valve apparatus, the structures that are spatially related to it and may be affected by the procedure, the right heart chambers and the right ventricular outflow tract.
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Affiliation(s)
- Luca Pugliese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesca Ricci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Alessandra Luciano
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Matteo Presicce
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Luigi Spiritigliozzi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Federica Di Tosto
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesca D'Errico
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Leonardo Benelli
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Monia Pasqualetto
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesco Grimaldi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Daniele Mecchia
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Paolo Sbordone
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Matteo Cesareni
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Cecilia Cerimele
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Martina Cerocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Mario Laudazi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Paola Leomanni
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Carlotta Rellini
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Vito Dell'Olio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Alberto Patanè
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesco Romeo
- Department of System Medicine, University of Rome Tor Vergata and Unit of Cardiology and Interventional Cardiology, Policlinico Tor Vergata, Rome, Italy
| | - Francesco Barillà
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesco Garaci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Roberto Floris
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
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22
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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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23
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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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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
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El-Sabrout H, Ganta S, Guyon P, Ratnayaka K, Vaughn G, Perry J, Kimball A, Ryan J, Thornburg CD, Tucker S, Mo J, Hegde S, Nigro J, El-Said H. Neonatal Myocardial Infarction: A Proposed Algorithm for Coronary Arterial Thrombus Management. Circ Cardiovasc Interv 2022; 15:e011664. [PMID: 35485231 DOI: 10.1161/circinterventions.121.011664] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neonatal myocardial infarction is rare and is associated with a high mortality of 40% to 50%. We report our experience with neonatal myocardial infarction, including presentation, management, outcomes, and our current patient management algorithm. METHODS We reviewed all infants admitted with a diagnosis of coronary artery thrombosis, coronary ischemia, or myocardial infarction between January 2015 and May 2021. RESULTS We identified 21 patients (median age, 1 [interquartile range (IQR), 0.25-9.00] day; weight, 3.2 [IQR, 2.9-3.7] kg). Presentation included respiratory distress (16), shock (3), and murmur (2). Regional wall motion abnormalities by echocardiogram were a key criterion for diagnosis and were present in all 21 with varying degrees of depressed left ventricular function (severe [8], moderate [6], mild [2], and low normal [5]). Ejection fraction ranged from 20% to 54% (median, 43% [IQR, 34%-51%]). Mitral regurgitation was present in 19 (90%), left atrial dilation in 15 (71%), and pulmonary hypertension in 18 (86%). ECG was abnormal in 19 (90%). Median troponin I was 0.18 (IQR, 0.12-0.56) ng/mL. Median BNP (B-type natriuretic peptide) was 2100 (IQR, 924-2325) pg/mL. Seventeen had documented coronary thrombosis by cardiac catheterization. Seventeen (81%) were treated with intracoronary tPA (tissue-type plasminogen activator) followed by systemic heparin, AT (antithrombin), and intravenous nitroglycerin, and 4 (19%) were treated with systemic heparin, AT, and intravenous nitroglycerin alone. Nineteen of 21 recovered. One died (also had infradiaphragmatic total anomalous pulmonary venous return). One patient required a ventricular assist device and later underwent heart transplant; this patient was diagnosed late at 5 weeks of age and did not respond to tPA. Nineteen of 21 (90%) regained normal left ventricular function (ejection fraction, 60%-74%; mean, 65% [IQR, 61%-67%]) at latest follow-up (median, 6.8 [IQR, 3.58-14.72] months). Two of 21 (10%) had residual trivial mitral regurgitation. After analysis of these results, we present our current algorithm, which developed and matured over time, to manage neonatal myocardial infarction. CONCLUSIONS We experienced a lower mortality rate for infants with neonatal infarction than that reported in the literature. We propose a post hoc algorithm that may lead to improvement in patient outcomes following coronary artery thrombus.
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Affiliation(s)
- Hannah El-Sabrout
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - Srujan Ganta
- Division of Pediatric Cardiac Surgery (S.G., J.N.), Rady Children's Hospital/University of California, San Diego
| | - Peter Guyon
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - Gabrielle Vaughn
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - James Perry
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - Amy Kimball
- Division of Neonatology (A.K.), Rady Children's Hospital/University of California, San Diego
| | - Justin Ryan
- 3D Innovation Lab (J.R.), Rady Children's Hospital/University of California, San Diego
| | - Courtney D Thornburg
- Division of Hematology (C.D.T.), Rady Children's Hospital/University of California, San Diego
| | - Suzanne Tucker
- Division of Pathology (S.T., J.M.), Rady Children's Hospital/University of California, San Diego
| | - Jun Mo
- Division of Pathology (S.T., J.M.), Rady Children's Hospital/University of California, San Diego
| | - Sanjeet Hegde
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
| | - John Nigro
- Division of Pediatric Cardiac Surgery (S.G., J.N.), Rady Children's Hospital/University of California, San Diego
| | - Howaida El-Said
- Division of Pediatric Cardiology (H. El-Sabrout, P.G., K.R., G.V., J.P., S.H., H. El-Said), Rady Children's Hospital/University of California, San Diego
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Gartenberg AJ, Gillespie MJ, Glatz AC. Transcatheter Approaches to Pulmonary Valve Replacement in Congenital Heart Disease: Revolutionizing the Management of RVOT Dysfunction? Semin Thorac Cardiovasc Surg 2022; 35:333-338. [DOI: 10.1053/j.semtcvs.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/11/2022]
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Fleming GA, Chamberlain RC. Ongoing Learning With Transcatheter Pulmonary Valve Replacement: Incremental Benefits Comparing Apples to Oranges. JACC Cardiovasc Interv 2022; 15:176-178. [PMID: 35057988 DOI: 10.1016/j.jcin.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Gregory A Fleming
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
| | - Reid C Chamberlain
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina, USA
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Samayoa JC, Boucek D, McCarthy E, Riley M, Ou Z, Tani LY, Hoskoppal AK, Gray RG, Martin MH. Echocardiographic Assessment of Melody Versus Sapien Valves Following Transcatheter Pulmonary Valve Replacement. JACC Cardiovasc Interv 2022; 15:165-175. [PMID: 35057987 DOI: 10.1016/j.jcin.2021.11.002] [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: 06/03/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to compare the immediate and midterm echocardiographic performance of the Melody (Medtronic Inc) and Sapien (Edwards Lifesciences Inc) valves after transcatheter pulmonary valve replacement (TPVR) in native and conduit right ventricular outflow tracts (RVOTs). BACKGROUND TPVR is now a common procedure, but limited data exist comparing postimplantation echocardiographic findings between Melody and Sapien valves. METHODS This was a single-institution retrospective cohort study of all patients who underwent successful TPVR from 2011 to 2020. Patient demographics, procedural details, and immediate and midterm echocardiographic findings were collected and compared between valve types using the Wilcoxon rank sum, chi-square, or Fisher exact test as appropriate. Subgroups were analyzed individually and were adjusted for multiple comparisons using the Bonferroni method. RESULTS A total of 328 patients underwent successful TPVR (Melody: n = 202, Sapien: n = 126). The groups had a similar baseline age, weight, and diagnosis. The most common indications for TPVR were pulmonary stenosis (32.2%) or mixed disease (46%) in the Melody group and pulmonary insufficiency in the Sapien group (52.4%) (P < 0.001). Sapien valves were more often placed in native RVOTs (43.7% vs 18.8%; P < 0.001). The discharge and follow-up mean and peak Doppler gradients were similar between the Melody and Sapien groups. Valves implanted in native RVOTs had significantly lower postimplantation gradients at each follow-up period. CONCLUSIONS Echocardiographic performance after TPVR was generally acceptable and similar when comparing Melody and Sapien valves despite differences in the indication and anatomy in each group. The peak and mean gradients were lower in transcatheter valves implanted in native RVOTs compared with those implanted in conduits or bioprosthetic valves.
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Affiliation(s)
- Juan Carlos Samayoa
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
| | - Dana Boucek
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Elisa McCarthy
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Michelle Riley
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Zhining Ou
- Division of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Lloyd Y Tani
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Arvind K Hoskoppal
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Robert G Gray
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Mary Hunt Martin
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
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Kalfa D. Novel Valve Choices for Pulmonary Valve Replacement. Semin Thorac Cardiovasc Surg 2022; 35:523-529. [PMID: 35032644 DOI: 10.1053/j.semtcvs.2021.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022]
Affiliation(s)
- David Kalfa
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital and Cardiac Surgery, Morgan Stanley Children Hospital -New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York.
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Sherif NEE, Taggart NW. Covered Stents in the Management of Aortic Coarctation and Right Ventricular Outflow Tract Obstruction. Curr Cardiol Rep 2022; 24:51-58. [PMID: 35028814 DOI: 10.1007/s11886-021-01623-y] [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] [Accepted: 09/30/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW To review the use of covered stents in the treatment of coarctation of the aorta (CoA) and right ventricle to pulmonary artery (RV-PA) conduit obstruction. RECENT FINDINGS The only commercially available covered stent approved for treatment of CoA and dysfunctional RV-PA conduits is the covered Cheatham-Platinum stent (CCPS). Early outcomes have demonstrated its safety and have suggested its efficacy in treating or preventing aortic wall injury (AWI) or conduit disruption. A recent study of CCPS use for CoA reported a progressive risk of stent fracture over time and a risk of AWI despite the purported protection that the CCPS provides. The use of other covered stents has been reported, but large, systematic studies are lacking. CCPS use may reduce but does not eliminate the risk of conduit disruption or AWI. Structural limitations of the CCPS may predispose it to stent fracture. Access to a broad range of covered stents continues to be an unmet need in the field of congenital interventional cardiology.
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Affiliation(s)
- Nibras E El Sherif
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nathaniel W Taggart
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
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Kang SL, Ramroop R, Manojlovich L, Runeckles K, Fan S, Chaturvedi RR, Lee KJ, Benson LN. Is there a role for endovascular stent implantation in the management of postoperative right ventricular outflow tract obstruction in the era of transcatheter valve implantation? Catheter Cardiovasc Interv 2021; 99:1138-1148. [PMID: 34967102 DOI: 10.1002/ccd.30043] [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: 10/31/2020] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The optimal management pathway for the dysfunctional right ventricular outflow tract (RVOT) is uncertain. We evaluated the long-term outcomes and clinical impact of stent implantation for obstructed RVOTs in an era of rapidly progressing transcatheter pulmonary valve technology. METHODS Retrospective review of 151 children with a biventricular repair who underwent stenting of obstructed RVOT between 1991 and 2017. RESULTS RVOT stenting resulted in significant changes in peak right ventricle (RV)-to-pulmonary artery (PA) gradient (39.4 ± 17.1-14.9 ± 8.3; p < 0.001) and RV-to-aortic pressure ratio (0.78 ± 0.22-0.49 ± 0.13; p < 0.001). Subsequent percutaneous reinterventions in 51 children to palliate recurrent stenosis were similarly effective. Ninety-nine (66%) children reached the primary outcome of subsequent pulmonary valve replacement (PVR). Freedom from PVR from the time of stent implantation was 91%, 51%, and 23% at 1, 5, and 10 years, respectively. Small balloon diameters for stent deployment were associated with shorter freedom from PVR. When additional children without stent palliation (with RV-to-PA conduits) were added to the stent cohort (total 506 children), the multistate analysis showed the longest freedom from PVR in those with stent palliation and subsequent catheter reintervention. Pulmonary regurgitation was well-tolerated clinically. Indexed RV dimensions and function estimated by echocardiography remained stable at last follow up or before primary outcome. CONCLUSION Prolongation of conduit longevity with stent implant remains an important strategy to allow for somatic growth to optimize the risk-benefit profile for subsequent surgical or transcatheter pulmonary valve replacement performed at an older age.
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Affiliation(s)
- Sok-Leng Kang
- Department of Pediatric Cardiology, Alder Hey Children's Hospital, Liverpool, UK
| | - Ronand Ramroop
- Department of Paediatric Medicine, Wendy Fitzwilliam's Childrens' Hospital, Eric Williams Medical Sciences Complex, Trinidad and Tobago, West Indies
| | - Larissa Manojlovich
- The Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Kyle Runeckles
- Ted Rogers Computational Program, Cardiovascular Data Management Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, Toronto, Canada
| | - Steve Fan
- Ted Rogers Computational Program, Cardiovascular Data Management Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, Toronto, Canada
| | - Rajiv R Chaturvedi
- Ted Rogers Computational Program, Cardiovascular Data Management Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, Toronto, Canada
| | - Kyong-Jin Lee
- Division of Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Lee N Benson
- The Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada
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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.
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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.)
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Acute and short-term haemodynamic impact of transcatheter pulmonary valve implantation on left ventricular systolic and diastolic function. Cardiol Young 2021; 31:1835-1841. [PMID: 33722314 DOI: 10.1017/s1047951121001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Assess the acute and short-term haemodynamic impact of transcatheter pulmonary valve implantation on left ventricular systolic and diastolic function stratified by pre-transcatheter pulmonary valve implantation physiology. BACKGROUND Transcatheter pulmonary valve implantation is a widely available option to treat residual or recurrent pulmonary stenosis and pulmonary insufficiency. Transcatheter pulmonary valve implantation acutely increases pulmonary artery size and diastolic pressure in patients with pulmonary insufficiency and acute pulmonary edema has been reported after transcatheter pulmonary valve implantation, possibly related to acute left ventricular volume loading. However, the impact of transcatheter pulmonary valve implantation on left ventricular diastolic function has not been established. METHODS Patients who underwent transcatheter pulmonary valve implantation from 2010 to 2017 at our centre were grouped by indication for transcatheter pulmonary valve implantation as pulmonary stenosis, pulmonary insufficiency, or mixed disease. Separate analysis was performed on those who underwent transcatheter pulmonary valve implantation for pulmonary stenosis versus pulmonary insufficiency or mixed disease. Intracardiac haemodynamics immediately before and after transcatheter pulmonary valve implantation and echocardiographic assessment of left ventricular systolic and diastolic function at baseline, 1-day post transcatheter pulmonary valve implantation, and 1-year post transcatheter pulmonary valve implantation were compared between groups. RESULTS In 102 patients who underwent transcatheter pulmonary valve implantation, the indication was pulmonary stenosis in 29 (28%), pulmonary insufficiency in 28 (29%), and mixed disease in 44 (43%). There were no significant differences in left ventricular systolic or diastolic function between groups at baseline, immediately after transcatheter pulmonary valve implantation, or 1-year post implantation. The mean pulmonary artery wedge pressure increased equally across groups. CONCLUSIONS While patients with pulmonary insufficiency likely have acute left ventricular volume loading following transcatheter pulmonary valve implantation, this does not appear to be haemodynamically significant as transcatheter pulmonary valve implantation was not associated with measurable changes in left ventricular systolic or diastolic function acutely or 1-year post implantation.
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Sheth K, Azad S, Dalvi B, Parekh M, Sagar P, Anantharaman R, Radhakrishnan S, Sivakumar K. Early multicenter experience of Melody valve implantation in India. Ann Pediatr Cardiol 2021; 14:302-309. [PMID: 34667400 PMCID: PMC8457271 DOI: 10.4103/apc.apc_73_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/04/2022] Open
Abstract
Background Transcatheter valves provide a safe and effective alternative to surgery for treating dysfunctional right ventricular outflow tracts (RVOTs). We present our early multicenter experience of percutaneous pulmonary valve implantation (PPVI) using Melody valve (Medtronic Inc., Minneapolis, MN). Methods Patients with stenosed conduits or degenerated bioprosthetic valves in RVOT with combined stenosis and regurgitation were evaluated for suitability of Melody valve implantation. After undergoing an initial structured training, PPVI using Melody transcatheter pulmonary valve (TPV) was guided by an approved proctor. Conduits were serially dilated and prestented with careful coronary interrogation, and bioprosthetic valves were dilated with high-pressure balloons. Clinical and echocardiographic follow-up was performed at 6 monthly intervals. Results Fifteen patients (three females) aged 23.1 ± 9.5 years in NYHA Class II-III underwent Melody TPV implantation in four Indian centers. The underlying anatomy comprised surgically implanted bioprosthetic valves for pulmonary regurgitation (n= 5), conduit repair for pulmonary atresia (n = 4), Rastelli repair (n = 3), truncus (n = 1), and Ross procedure (n = 2). Twelve patients had more than one previous surgery. Doppler gradient decreased from 74.2 ± 21.5 mmHg to 10.2 ± 4.5 mmHg after the PPVI. At a median follow-up of 14 months (1-39 months), all the patients were in NYHA Class I with echocardiographic gradients of 8 ± 5.7 mmHg with no evidence of pulmonary regurgitation. There were no major procedural adverse events or deaths. Conclusions Our early experience shows encouraging results of the PPVI program in India with proctored case selection and meticulous planning. It also confirms the safety and efficacy of Melody TPV for treating dysfunctional RVOT in postoperative patients.
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Affiliation(s)
- Kshitij Sheth
- Department of Pediatric Cardiology, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Sushil Azad
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Bharat Dalvi
- Department of Pediatric Cardiology, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Maulik Parekh
- Department of Pediatric Cardiology, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Pramod Sagar
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Rajaram Anantharaman
- Department of Pediatric Cardiology, Frontier Lifeline Hospital, Chennai, Tamil Nadu, India
| | | | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
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Sivakumar K, Sagar P, Qureshi S, Promphan W, Sasidharan B, Awasthy N, Kappanayil M, Suresh PV, Koneti NR. Outcomes of Venus P-valve for dysfunctional right ventricular outflow tracts from Indian Venus P-valve database. Ann Pediatr Cardiol 2021; 14:281-292. [PMID: 34667398 PMCID: PMC8457277 DOI: 10.4103/apc.apc_175_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 12/05/2022] Open
Abstract
Background : Balloon-expandable pulmonary valves are usually not suitable for dilated native outflow tracts. Methods : Indian Venus P-valve registry was retrospectively analyzed for efficacy, complications, and midterm outcomes. Straight valve was used in prestented conduits in patients with right ventricular pressure above two-thirds systemic pressure and/or right ventricular dysfunction. Flared valve 1–4 mm larger than balloon waist was used in native outflow in symptomatic patients, large ventricular volumes, and ventricular dysfunction. Objectives : A self-expanding porcine pericardial Venus P-valve is available in straight and flared designs.. Results : Twenty-nine patients were included. Straight valve was successful in all seven conduits, reducing gradients significantly, including one patient with left pulmonary artery (LPA) stent. Flared valve was successfully implanted in 20 out of 22 native outflow tracts. Sharp edges of the older design contributed to two failures. Complications included two migrations with one needing surgery, endocarditis in one, insignificant wire-frame fractures in three, and groin vascular complication in one patient. There were no deaths or valve-related reinterventions at a mean follow-up of 47.8 ± 24.5 months (1–85 months). Modifications of technique succeeded in three patients with narrow LPA. There was significant improvement in symptoms, right ventricular volume, and pulmonary regurgitant fraction. Conclusion : Straight and flared Venus P-valves are safe and effective in appropriate outflow tracts. Straight valve is an alternative to balloon-expandable valves in stenosed conduits. Flared valve is suitable for large outflows up to 34 mm, including patients with LPA stenosis. Recent design modifications may correct previous technical failures. Studies should focus on durability and late complications.
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Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Shakeel Qureshi
- Department of Pediatric Cardiology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS, London, UK
| | - Worakan Promphan
- Department of Pediatric Cardiology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Bijulal Sasidharan
- Department of Pediatric Cardiology, Sree Chitra Tirunal Institute, Thiruvananthapuram, Kerala, India
| | - Neeraj Awasthy
- Department of Pediatric Cardiology, Max Super Specialty Hospital, Delhi, India
| | - Mahesh Kappanayil
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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The 100 most influential articles in congenital heart disease in 2000–2020: A bibliometric analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hazekamp MG, Barron DJ, Dangel J, Homfray T, Jongbloed MRM, Voges I. Consensus document on optimal management of patients with common arterial trunk. Eur J Cardiothorac Surg 2021; 60:7-33. [PMID: 34017991 DOI: 10.1093/ejcts/ezaa423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Mark G Hazekamp
- Department of Cardiothoracic Surgery, University Hospital Leiden, Leiden, Netherlands
| | - David J Barron
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Joanna Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Tessa Homfray
- Department of Medical Genetics, Royal Brompton and Harefield hospitals NHS Trust, London, UK
| | - Monique R M Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Inga Voges
- Department for Congenital Cardiology and Pediatric Cardiology, University Medical Center of Schleswig-Holstein, Kiel, Germany
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Watanabe N, Toh N, Takaya Y, Nakayama R, Yokohama F, Osawa K, Miyoshi T, Akagi T, Kanazawa S, Ito H. Usefulness of cardiac fusion imaging with computed tomography and Doppler echocardiography in the assessment of conduit stenosis in complex adult congenital heart disease. J Cardiol 2021; 78:473-479. [PMID: 34266716 DOI: 10.1016/j.jjcc.2021.06.008] [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: 02/16/2021] [Revised: 05/20/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Noninvasive assessment of stenotic lesions in patients with complex adult congenital heart disease (ACHD) is challenging due to its complex morphology. The simultaneous two-screen display of multidetector-computed tomography (MDCT) and real-time echogram (STDME) technology can display a virtual multi-planar reconstruction from MDCT corresponding to the same cross-sectional image from transthoracic echocardiography (TTE). We investigated the usefulness of the STDME technology for stenosis severity assessment in complex ACHD patients. METHODS Twenty-four complex ACHD patients with stenotic lesions were enrolled in this study. All patients underwent TTE and the STDME technology within a week after MDCT. Peak velocity and pressure gradient (PG) across the stenotic site were measured using continuous wave Doppler. Cardiac catheterization was performed in 17 patients. RESULTS Nine out of the twenty-four patients had undergone repair with a conduit. Peak velocity and PG from the STDME technology were higher than those from TTE (peak velocity: 3.1 ± 1.1 vs. 2.8 ± 1.0 m/s; peak PG: 43 ± 28 vs. 34 ± 21 mmHg; both p < 0.01). Peak PG from the STDME technology showed significant correlations with those from catheterization in patients with a conduit (n=7) and those without a conduit (n=10) (r = 0.795 and 0.880, respectively; both p < 0.05), while peak PG from TTE was correlated with catheterization measurements only in patients without a conduit (r = 0.850, p < 0.05). CONCLUSIONS The STDME technology enables more accurate assessment of conduit stenosis severity than does TTE in complex ACHD patients.
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Affiliation(s)
- Nobuhisa Watanabe
- Center of Ultrasonic Diagnostics, Okayama University Hospital, Okayama, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Fumi Yokohama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuhiro Osawa
- Department of Cardiovascular Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Bazylev VV, Shmatkov MG, Voevodin AB, Chernogrivov IE. [First serial transcatheter implantation of pulmonary valve using MedLab-KT prosthesis]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:135-145. [PMID: 34166354 DOI: 10.33529/angio2021206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Surgical treatment of 'blue' congenital heart defects frequently implies various interventions on the outlet portion of the right ventricle or pulmonary artery trunk. Most often used are various conduits, reconstructing the outlet portion of the right ventricle and pulmonary artery. Most patients having previously endured the mentioned interventions, would in the remote terms require repeat operative procedures for stenosis or insufficiency on the pulmonary valve or the implanted conduit. Taking into account complexity and the risk of open interventions, the current trends are towards more frequent use of transcatheter implantation of the pulmonary valve. AIM The purpose of this work is to present the first serial experience with hybrid transventricular implantation of an original Russian-made valve into the position of the pulmonary artery. PATIENTS AND METHODS We retrospectively studied a series of 5 clinical cases who from July 2019 to May 2020 at the Federal Centre of Cardiovascular Surgery (Penza) had underwent hybrid transventricular implantation of the first Russian-made valve-containing stent (MedLab-KT) into the position of the pulmonary valve, with the stent's closing component consisting of leaflets made of polytetrafluoroethylene. RESULTS 3 patients underwent implantation of valve # 25 and 2 subjects received valve # 23, with all cases yielding good immediate results. The haemodynamic parameters of the implanted prosthesis were optimal. In all cases, the significant gradient was absent and regurgitation did not exceed grade I. There was no in-hospital mortality. The method of hybrid prosthetic repair of the pulmonary valve via the transapical right-ventricular access from the left lateral mini-thoracotomy was aimed at reducing potential risks of artificial circulation, also contributing to a significant decrease in the traumatic nature of surgical treatment of patients requiring a repeat intervention for pulmonary valve pathology.
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Affiliation(s)
- V V Bazylev
- Federal Centre of Cardiovascular Surgery of the RF Ministry of Public Health, Penza, Russia
| | - M G Shmatkov
- Federal Centre of Cardiovascular Surgery of the RF Ministry of Public Health, Penza, Russia
| | - A B Voevodin
- Federal Centre of Cardiovascular Surgery of the RF Ministry of Public Health, Penza, Russia
| | - I E Chernogrivov
- Federal Centre of Cardiovascular Surgery of the RF Ministry of Public Health, Penza, Russia
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Hofferberth SC, Saeed MY, Tomholt L, Fernandes MC, Payne CJ, Price K, Marx GR, Esch JJ, Brown DW, Brown J, Hammer PE, Bianco RW, Weaver JC, Edelman ER, Del Nido PJ. A geometrically adaptable heart valve replacement. Sci Transl Med 2021; 12:12/531/eaay4006. [PMID: 32075944 DOI: 10.1126/scitranslmed.aay4006] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022]
Abstract
Congenital heart valve disease has life-threatening consequences that warrant early valve replacement; however, the development of a growth-accommodating prosthetic valve has remained elusive. Thousands of children continue to face multiple high-risk open-heart operations to replace valves that they have outgrown. Here, we demonstrate a biomimetic prosthetic valve that is geometrically adaptable to accommodate somatic growth and structural asymmetries within the heart. Inspired by the human venous valve, whose geometry is optimized to preserve functionality across a wide range of constantly varying volume loads and diameters, our balloon-expandable synthetic bileaflet valve analog exhibits similar adaptability to dimensional and shape changes. Benchtop and acute in vivo experiments validated design functionality, and in vivo survival studies in growing sheep demonstrated that mechanical valve expansion accommodated growth. As illustrated in this work, dynamic size adaptability with preservation of unidirectional flow in prosthetic valves thus offers a paradigm shift in the treatment of heart valve disease.
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Affiliation(s)
- Sophie C Hofferberth
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Mossab Y Saeed
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Lara Tomholt
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA 02138, USA.,Harvard Graduate School of Design, Harvard University, Cambridge, MA 02138, USA
| | - Matheus C Fernandes
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA 02138, USA.,John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Christopher J Payne
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Karl Price
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Gerald R Marx
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jesse J Esch
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - David W Brown
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jonathan Brown
- Biomedical Engineering Center, Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Peter E Hammer
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Richard W Bianco
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - James C Weaver
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA 02138, USA
| | - Elazer R Edelman
- Biomedical Engineering Center, Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Callahan CP, Jegatheeswaran A, Blackstone EH, Karamlou T, Baird CW, Ramakrishnan K, Herrmann JL, Brown JW, Nelson JS, Polimenakos AC, Lambert LM, Eckhauser AW, Kirklin JK, DeCampli WM, Aghaei N, St Louis JD, McCrindle BW. Time-related risk of pulmonary conduit re-replacement: a Congenital Heart Surgeons' Society Study. Ann Thorac Surg 2021; 113:623-629. [PMID: 34097895 DOI: 10.1016/j.athoracsur.2021.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/30/2021] [Accepted: 05/06/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients receiving a right ventricle-to-pulmonary artery conduit in infancy will require successive procedures or replacements, each with variable longevity. We sought to identify factors associated with time-related risk of a subsequent surgical replacement (PC3) or transcatheter pulmonary valve insertion (TPVI) after a second surgically-placed PC (PC2). METHODS From 2002 to 2016, 630 patients from 29 Congenital Heart Surgeons' Society member institutions survived to discharge after initial valved PC insertion (PC1) at age < 2 years. Of those, 355 had undergone surgical replacement (PC2) of that initial conduit. Competing risk methodology and multiphase parametric hazard analyses were used to identify factors associated with time-related risk of PC3 or TPVI. RESULTS Of 355 PC2 patients (median follow-up of 5.3 years), 65 underwent PC3 and 41 TPVI. Factors at PC2 associated with increased time-related risk of PC3 were smaller PC2 Z score (Hazard Ratio [HR] 1.6, p<0.001), concomitant aortic valve intervention (HR 7.6, p=0.009), aortic allograft (HR 2.2, p=0.008), younger age (HR 1.4, p<0.001), and larger Z score of PC1 (HR 1.2, p=0.04). Factors at PC2 associated with increased time-related risk of TPVI were aortic allograft (HR: 3.3, p=0.006), porcine unstented conduit (HR 4.7, p<0.001), and older age (HR 2.3, p=0.01). CONCLUSIONS Aortic allograft as PC2 was associated with increased time-related risk of both PC3 and TPVI. Surgeons may reduce risk of these subsequent procedures by not selecting an aortic homograft at PC2, and by oversizing the conduit when anatomically feasible.
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Affiliation(s)
- Connor P Callahan
- Division of Cardiovascular Surgery, The Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada
| | - Anusha Jegatheeswaran
- Division of Cardiovascular Surgery, The Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada
| | - Eugene H Blackstone
- Division of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195
| | - Tara Karamlou
- Division of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115
| | - Karthik Ramakrishnan
- Department of Cardiovascular Surgery, Children's National Health System, 111 Michigan Ave NW, Washington, DC 20010
| | - Jeremy L Herrmann
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Riley Children's Health, 705 Riley Hospital Dr., Indianapolis, IN 46202
| | - John W Brown
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Riley Children's Health, 705 Riley Hospital Dr., Indianapolis, IN 46202
| | - Jennifer S Nelson
- Department of Cardiac Surgery, Nemours Children's Hospital, 6535 Nemours Pkwy, Orlando, FL 32827
| | - Anastasios C Polimenakos
- Pediatric and Congenital Cardiothoracic Surgery, The Methodist Children's Heart Institute, 7700 Floyd Curl Dr, San Antonio, TX 78229
| | - Linda M Lambert
- Pediatric Cardiothoracic Surgery, University of Utah/Primary Children's Medical Center, 100 Mario Capecchi Dr, Salt Lake City, UT 84113
| | - Aaron W Eckhauser
- Pediatric Cardiothoracic Surgery, University of Utah/Primary Children's Medical Center, 100 Mario Capecchi Dr, Salt Lake City, UT 84113
| | - James K Kirklin
- Department of Surgery, University of Alabama at Birmingham, 703 19(th) St S, Birmingham, AL 35294
| | - William M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, 92 W Miller St., Orlando FL 32806
| | - Nabi Aghaei
- Congenital Heart Surgeons' Society Data Center, The Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada
| | - James D St Louis
- Pediatric and Congenital Heart Surgery, Children's Hospital of Georgia, 1446 Harper St., Augusta, GA 30912
| | - Brian W McCrindle
- Division of Pediatric Cardiology, The Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada.
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Saef JM, Ghobrial J. Valvular heart disease in congenital heart disease: a narrative review. Cardiovasc Diagn Ther 2021; 11:818-839. [PMID: 34295708 DOI: 10.21037/cdt-19-693-b] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/29/2021] [Indexed: 12/29/2022]
Abstract
Patients with congenital heart disease (CHD) are one of the fastest growing populations in cardiology, and valvular pathology is at the center of many congenital lesions. Derangements in valvular embryology lead to several anomalies prone to dysfunction, each with hemodynamic effects that require appropriate surveillance and management. Surgical innovation has provided new treatments that have improved survival in this population, though has also contributed to esotericism in patients who already have unique anatomic and physiologic considerations. Conduit and prosthesis durability are often monitored collaboratively with general and specialized congenital-focused cardiologists. As such, general cardiologists must become familiar with valvular disease with CHD for appropriate care and referral practices. In this review, we summarize the embryology of the semilunar and atrioventricular (AV) valves as a foundation for understanding the origins of valvular CHD and describe the mechanisms that account for heterogeneity in disease. We then highlight the categories of pathology from the simple (e.g., bicuspid aortic valve, isolated pulmonic stenosis) to the more complex (e.g., Ebstein's anomaly, AV valvular disease in single ventricle circulations) with details on natural history, diagnosis, and contemporary therapeutic approaches. Care for CHD patients requires collaborative effort between providers, both CHD-specialized and not, to achieve optimal patient outcomes.
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Affiliation(s)
- Joshua M Saef
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joanna Ghobrial
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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46
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Acute and mid-term outcomes of transcatheter pulmonary valve implantation in patients older than 40 years. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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47
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Breatnach CR, McGuinness J, Ng LY, Franklin O, Redmond M, Nölke L, McMahon C, Oslizlok P, Walsh K, Kenny D. Procedural technique for hybrid pulmonary valve replacement in infants and small children. Eur J Cardiothorac Surg 2021; 59:823-830. [PMID: 33253364 DOI: 10.1093/ejcts/ezaa410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Hybrid approach to pulmonary valve replacement (PVR) in the paediatric population has been reported, although data in infants and small children are limited. Several strategies are now possible. The aim of this study is to review our hybrid PVR strategy in a complex patient cohort, outlining a variety of approaches employed in our centre. METHODS We performed a retrospective review of infants and small children who underwent hybrid PVR between May 2017 and April 2019 in a single tertiary cardiology centre. Medical records were reviewed to ascertain demographic, clinical and outcome data. RESULTS Ten patients with a median (interquartile range) age of 1.5 years (1.1-1.9) and weight of 8.8 kg (8-10.6) were managed with hybrid pulmonary valve insertion. Eight patients had perventricular approach (4 sternotomy and 4 subxiphoid) and 2 patients had surgically sutured valve. Six patients underwent cardiopulmonary bypass for associated lesions. Three had insertion of the valve into conduits and 7 were deployed into native right ventricular outflow tracts. The pulmonary valve was successfully inserted in all 10 patients with no mortality. Postprocedural complications included paravalvar leak in 2 patients, suspected endocarditis in 1 patient who developed early valve regurgitation and wound infection in 1 patient. CONCLUSIONS Several approaches to hybrid PVR may be employed in small children with a high success rate. Follow-up studies are required to evaluate longer term durability of these approaches compared to standard surgical replacement.
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Affiliation(s)
- Colm R Breatnach
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Jonathan McGuinness
- Department of Cardiothoracic Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Li Yen Ng
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Orla Franklin
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Mark Redmond
- Department of Cardiothoracic Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Lars Nölke
- Department of Cardiothoracic Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Colin McMahon
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Paul Oslizlok
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Kevin Walsh
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Damien Kenny
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
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Kreutzer J, Armstrong AK, Rome JJ, Zellers TM, Balzer DT, Zampi JD, Cabalka AK, Javois AJ, Turner DR, Gray RG, Moore JW, Weng S, Jones TK, Khan DM, Vincent JA, Hellenbrand WE, Cheatham JP, Bergersen LJ, McElhinney DB. Comparison of the investigational device exemption and post-approval trials of the Melody transcatheter pulmonary valve. Catheter Cardiovasc Interv 2021; 98:E262-E274. [PMID: 33780150 DOI: 10.1002/ccd.29657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/03/2020] [Accepted: 03/14/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We compared 5-year outcomes of transcatheter pulmonary valve (TPV) replacement with the Melody TPV in the post-approval study (PAS) and the investigational device exemption (IDE) trial. BACKGROUND As a condition of approval of the Melody TPV after the IDE trial, the Food and Drug Administration required that a PAS be conducted to evaluate outcomes of TPV replacement in a "real-world" environment. The 5-year outcomes of the PAS have not been published, and the IDE and PAS trials have not been compared. METHODS The cohorts comprised all patients catheterized and implanted at 5 IDE sites and 10 PAS sites. Differences in trial protocols were detailed. Time-related outcomes and valve-related adverse events were compared between the two trials with Kaplan-Meier curves and log-rank testing. RESULTS 167 patients (median age, 19 years) were catheterized and 150 underwent TPV replacement in the IDE trial; 121 were catheterized (median age, 17 years) and 100 implanted in the PAS. Freedom from hemodynamic dysfunction (p = .61) or any reintervention (p = .74) over time did not differ between trials. Freedom from stent fracture (p = .003) and transcatheter reintervention (p = .010) were longer in PAS, whereas freedom from explant (p = .020) and TPV endocarditis (p = .007) were shorter. Clinically important adverse events (AEs) were reported in 14% of PAS and 7.2% of IDE patients (p = .056); the incidence of any particular event was low in both. CONCLUSIONS Hemodynamic and time-related outcomes in the PAS and IDE trials were generally similar, confirming the effectiveness of the Melody TPV with real-world providers. There were few significant complications and limited power to identify important differences in AEs. The lack of major differences in outcomes between the two studies questions the usefulness of mandated costly post-approval studies as part of the regulatory process for Class III medical devices.
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Affiliation(s)
- Jacqueline Kreutzer
- Division of Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jonathan J Rome
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Thomas M Zellers
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern and the Heart Center at Children's Health, Dallas, Texas, USA
| | - David T Balzer
- Division of Pediatric Cardiology, Washington University School of Medicine/Saint Louis Children's Hospital, St. Louis, Missouri, USA
| | - Jeffrey D Zampi
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Alexander J Javois
- Advocate Children's Hospital, Section of Pediatric Cardiology, Advocate Children's Hospital, University of Illinois Hospital, Chicago, Illinois, USA
| | - Daniel R Turner
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Robert G Gray
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, USA
| | - John W Moore
- Department of Pediatric Cardiology, Rady Children's Hospital, UC San Diego, San Diego, California, USA
| | - Shicheng Weng
- Department of Biostatistics, Medtronic, Framingham, Massachusetts, USA
| | - Thomas K Jones
- Department of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Danyal M Khan
- The Heart Program, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Julie A Vincent
- Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York, USA
| | - William E Hellenbrand
- Department of Pediatrics (Cardiology), Yale University School of Medicine, New Haven, Connecticut, USA
| | - John P Cheatham
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lisa J Bergersen
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
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49
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Jalal Z, Valdeolmillos E, Malekzadeh-Milani S, Eicken A, Georgiev S, Hofbeck M, Sieverding L, Gewillig M, Ovaert C, Bouvaist H, Pillois X, Thambo JB, Boudjemline Y. Mid-Term Outcomes Following Percutaneous Pulmonary Valve Implantation Using the "Folded Melody Valve" Technique. Circ Cardiovasc Interv 2021; 14:e009707. [PMID: 33726503 PMCID: PMC8055198 DOI: 10.1161/circinterventions.120.009707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: The folded valve is a manual shortening of the Melody device, which has been validated as a valuable therapeutic option for the management of dysfunctional right ventricular outflow tracts needing a short valved stent. In this article, we aimed to evaluate, in a multicenter cohort, the mid-term outcomes of patients in whom a percutaneous pulmonary valve implantation was performed using the folded valve technique. Methods: A 2012 to 2018 retrospective multicenter study was performed in 7 European institutions. All patients who benefit from percutaneous pulmonary valve implantation with a folded Melody valve were included. Results: A total of 49 patients (median age, 19 years [range 4–56], 63% male) were included. The primary percutaneous pulmonary valve implantation indication was right ventricular outflow tract stenosis (n=19; 39%), patched native right ventricular outflow tracts were the most common substrate (n=15; 31%). The folded technique was mostly used in short right ventricular outflow tracts (n=28; 57%). Procedural success was 100%. After a median follow-up of 28 months (range, 4–80), folded Melody valve function was comparable to the immediate postimplantation period (mean transvalvular peak velocity=2.6±0.6 versus 2.4±0.6 m/s, P>0.1; only 2 patients had mild pulmonary regurgitation). Incidence rate of valve-related reinterventions was 2.1% per person per year (95% CI, 0.1%–3.9%). The probability of survival without valve-related reinterventions at 36 months was 90% (95% CI, 76%–100%). Conclusions: The folded Melody valve is a safe technique with favorable mid-term outcomes up to 6.5 years after implantation, comparable with the usual Melody valve implantation procedure. Complications and reinterventions rates were low, making this technique relevant in selected patients.
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Affiliation(s)
- Zakaria Jalal
- Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology, Pessac, France (Z.J., E.V., J.-B.T.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (Z.J., E.V., X.P., J.-B.T.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (Z.J., E.V., X.P., J.-B.T.)
| | - Estíbaliz Valdeolmillos
- Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology, Pessac, France (Z.J., E.V., J.-B.T.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (Z.J., E.V., X.P., J.-B.T.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (Z.J., E.V., X.P., J.-B.T.)
| | - Sophie Malekzadeh-Milani
- Department of Congenital and Pediatric Cardiology, Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Pediatric Cardiology, France (S.M.-M.)
| | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Germany (A.E., S.G.)
| | - Stanimir Georgiev
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Germany (A.E., S.G.)
| | - Michael Hofbeck
- Department of Pediatric Cardiology, University Children's Hospital, Tuebingen, Germany (M.H., L.S.)
| | - Ludger Sieverding
- Department of Pediatric Cardiology, University Children's Hospital, Tuebingen, Germany (M.H., L.S.)
| | - Marc Gewillig
- Department of Pediatric Cardiology, University Hospitals Leuven, Belgium (M.G.)
| | - Caroline Ovaert
- Department of Pediatric Cardiology and Congenital Heart Disease, AP-HM, Timone enfants, Hopital de la Timone, Provence-Alpes-Côte d'Azur, France (C.O.)
| | | | - Xavier Pillois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (Z.J., E.V., X.P., J.-B.T.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (Z.J., E.V., X.P., J.-B.T.)
| | - Jean-Benoit Thambo
- Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology, Pessac, France (Z.J., E.V., J.-B.T.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (Z.J., E.V., X.P., J.-B.T.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (Z.J., E.V., X.P., J.-B.T.)
| | - Younes Boudjemline
- Cardiac Catheterization Laboratories, Sidra Heart Center, Sidra Medicine, Doha, Qatar (Y.B.)
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50
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Evaluation and Management of Pulmonic Valve Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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