Percutaneous Pulmonary Valve Implantation in the Young 2-Year Follow-Up

Department of Pediatrics, The Hospital for Sick Children, The Labatt Family Heart Centre, University of Toronto School of Medicine, Toronto, Canada.
JACC. Cardiovascular Interventions (Impact Factor: 7.44). 04/2010; 3(4):439-48. DOI: 10.1016/j.jcin.2010.02.003
Source: PubMed

ABSTRACT The aim of this study was to investigate physiological and clinical consequences of percutaneous pulmonary valve implantation (PPVI) in patients with chronic right ventricular outflow tract (RVOT) obstruction and volume overload.
The PPVI is a nonsurgical technique to address RVOT conduit dysfunction.
Twenty-eight adolescents (median age 14.9 years; age range 10.9 to 19 years) underwent PPVI due to RVOT stenosis and/or pulmonary regurgitation (PR). Before and after PPVI echocardiographic and magnetic resonance imaging, cardiopulmonary exercise tests were obtained.
The RVOT gradient (p < 0.001) and right ventricular (RV) systolic pressure decreased (p < 0.001), acutely. Magnetic resonance imaging (median 6 months) documented reduction in RV end-diastolic (149 +/- 49 ml/m(2) vs. 114 +/- 35 ml/m(2), p < 0.005) volume, increases in left ventricular (LV) end-diastolic (p < 0.007) volume and cardiac output (RV: p < 0.04 and LV: p < 0.02), and reduced PR fraction (24 +/- 10% to 7 +/- 7%, p < 0.0001). Symptoms, aerobic exercise performance (maximal oxygen consumption: p < 0.0001) and ventilatory response to carbon dioxide production (p < 0.003) improved. After 24 months, echocardiography demonstrated the RV/systemic-pressure ratio, and RVOT peak pressure gradient reductions persisted, and PR was absent in 93% (n = 12 of 13) of the cohort. Freedom from surgery was 91%, 83%, and 83%, and freedom from transcatheter reintervention was 91%, 80%, and 80%, at 12, 24, and 36 months, respectively. There were no acute device-related complications, with stent fractures noted in 10.8%.
Percutaneous pulmonary valve implantation is feasible and safe in the young with dysfunctional RVOT conduits. An improvement in symptoms, hemodynamic status, and objective findings of exercise performance occurs. Early follow-up demonstrates persistent improvement in ventricular parameters, PR, and objective exercise capacity.

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Available from: Eric Horlick, Nov 09, 2014
    • "Badheka). 1 The authors share equal contribution to this manuscript. results of this study and its continuing study done by McElhinney et al. [3] demonstrated substantial clinical improvement in patients who underwent Melody TPV implantation procedure, which were similar to previously reported cohort study data on non-surgically approached transcutaneous pulmonary valve implantation [4] [5] [6]. "
    International journal of cardiology 07/2015; 199:186-188. DOI:10.1016/j.ijcard.2015.07.021 · 6.18 Impact Factor
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    • "However, early results suggest that PPVI with the Melody stent may have a more ambitious outlook. Our study confirms the good results of Melody valved stents in the right ventricular outflow tract during implantation and early follow-up [11]; moreover, good conduit function is maintained during medium term follow-up. Good mid-term function of the Melody conduit depends on good function of the different components of the prosthesis: the stent, the tissue conduit and the cusps. "
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    ABSTRACT: Introduction: Data on long term function of the Melody valve are scarce. Patients and methods: single institution; results of percutaneous pulmonary valve implantation (PPVI) from 2006 to 2014. The function of the valved conduit was analyzed by Doppler echocardiography. Annual Chest Xray after implant and permanent screening for events (e.g. Endocarditis). Results: 112 Melody valves were implanted in 111 patients; mean age 19.3 years (4.5–81.6). No pre-stenting of the RVOT was performed (n= 4) at first. In the next 107 patients pre-stenting was always performed. In 82 patients 1 pre-stent, 18 patients 2, in 6 patients 3 stents and 1 patient 4 stents were used. The Melody stent was dilated up to 24 mm (n= 4), 22 mm (n = 72), 20 mm (n = 28) and 18 mm (n= 6). When stenotic, the Doppler gradient reduced from 67.0 mm Hg (SD 13.9) to 18.9 mm Hg (SD 10.4) (p b 0.001); pulmonary regurgitation (PR) was reduced from median 3.5/4 (range 0–4/4) to none or trivial (p b 0.001). There was no significant change in RVOT peak velocity at 5 years (p = 0.122) nor PR (p = 0.835). Type 1 stent fractures were observed in 1/4 non-pre-stented patients and in 5/107 pre-stented (p b 0.05). Endocarditis occurred in 8/112 valves; freedom of endocarditis was 85% at 5 years. In 2 patients early surgical replacement was necessary. Six were sterilized with antibiotic treatment; 2 patients required re-stenting and re-PPVI due to residual gradient. Conclusion: Adequate pre-stenting of the RVOT before PPVI nearly abolishes or delays stent fracture. Cusp function is well preserved in mid-term follow-up; endocarditis is a threat.
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    ABSTRACT: Since first reported in 2000, transcatheter (percutaneous) pulmonary valve (TPV) replacement has become an important tool for the management postoperative right ventricular outflow tract (RVOT) dysfunction in patients with congenital heart disease, either as alternative or adjunct to surgery. Implantation of a pulmonary valve for treatment of RVOT obstruction or pulmonary regurgitation without performing open-heart surgery offers obvious appeal, and short-term results from multiple institutions throughout the world support the effectiveness and safety of this therapy. At present, there are two TPV prostheses available in the U.S.: the Medtronic Melody® valve is available commercially, and the Edwards Sapien® valve is available at limited centers as part of an investigational protocol. Although TPV therapy is likely to have a major impact on the management of postoperative RVOT dysfunction in patients with congenital heart disease or a Ross procedure, the technology is young and there is much that remains to be learned.
    06/2013; 1(2). DOI:10.1007/s40124-013-0013-9
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