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European Heart Journal Jul 2019
Topics: Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Pulmonary Valve; Registries
PubMed: 31114896
DOI: 10.1093/eurheartj/ehz320 -
Cardiology in the Young Dec 2014Despite tremendous advances in surgical treatment of tetralogy of Fallot, augmenting the small right ventricular outflow tract remains a challenge. Transannular patch... (Review)
Review
Despite tremendous advances in surgical treatment of tetralogy of Fallot, augmenting the small right ventricular outflow tract remains a challenge. Transannular patch augmentation revolutionised surgical management, but did so at the expense of rendering patients with pulmonary insufficiency and the resulting problems associated therewith. Recent surgical efforts have focused on pulmonary valve preservation at initial correction and pulmonary valve restoration after transannular patching, with favourable results. In this manuscript, we review methods of pulmonary valve preservation and restoration.
Topics: Cardiac Surgical Procedures; Humans; Infant; Infant, Newborn; Pulmonary Valve; Pulmonary Valve Insufficiency; Tetralogy of Fallot
PubMed: 25647383
DOI: 10.1017/S1047951114001991 -
Catheterization and Cardiovascular... Feb 2019The Edwards Sapien S3 demonstrated clinical and technical feasibility in this cohort undergoing percutaneous pulmonary valve implantation. Traversing the tricuspid...
The Edwards Sapien S3 demonstrated clinical and technical feasibility in this cohort undergoing percutaneous pulmonary valve implantation. Traversing the tricuspid apparatus with an unsheathed delivery system continues to pose a risk for tricuspid valve injury. Future design innovations need to accommodate for large outflow tracts without adjacent aortic or coronary compression and allow for safe device delivery with minimal trauma to the tricuspid apparatus.
Topics: Aortic Valve; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Off-Label Use; Prosthesis Design; Pulmonary Valve; Treatment Outcome
PubMed: 30770667
DOI: 10.1002/ccd.28141 -
JACC. Cardiovascular Interventions May 2022
Topics: Cardiac Catheterization; Coronary Vessels; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Treatment Outcome
PubMed: 35512923
DOI: 10.1016/j.jcin.2022.03.031 -
World Journal For Pediatric &... Sep 2016The author's approach to the management of tetralogy of Fallot with absent pulmonary valve is described, including the technique of homograft replacement of the central... (Review)
Review
The author's approach to the management of tetralogy of Fallot with absent pulmonary valve is described, including the technique of homograft replacement of the central pulmonary arteries for the neonate who presents with profound respiratory compromise.
Topics: Blood Vessel Prosthesis; Cardiac Surgical Procedures; Disease Management; Humans; Infant, Newborn; Pulmonary Valve; Tetralogy of Fallot; Transplantation, Homologous
PubMed: 27587495
DOI: 10.1177/2150135116651838 -
Interactive Cardiovascular and Thoracic... Sep 2022Residual regurgitation is common after congenital surgery for right ventricular outflow tract malformation. It is accepted as there is no competent valve solution in a...
OBJECTIVES
Residual regurgitation is common after congenital surgery for right ventricular outflow tract malformation. It is accepted as there is no competent valve solution in a growing child. We investigated a new surgical technique of trileaflet semilunar valve reconstruction possessing the potential of remaining sufficient and allowing for some growth with the child. In this proof-of-concept study, our aim was to evaluate if it is achievable as a functional pulmonary valve reconstruction in vitro.
METHODS
Explanted pulmonary trunks from porcine hearts were evaluated in a pulsatile flow-loop model. First, the native pulmonary trunk was investigated, after which the native leaflets were explanted. Then, trileaflet semilunar valve reconstruction was performed and investigated. All valves were initially investigated at a flow output of 4 l/min and subsequently at 7 l/min. The characterization was based on hydrodynamic pressure and echocardiographic measurements.
RESULTS
Eight pulmonary trunks were evaluated. All valves are competent on colour Doppler. There is no difference in mean pulmonary systolic artery pressure gradient at 4 l/min (P = 0.32) and at 7 l/min (P = 0.20). Coaptation length is increased in the neo-valve at 4 l/min (P < 0.001, P < 0.001, P = 0.008) and at 7 l/min (P < 0.001, P = 0.006, P = 0.006). A windmill shape is observed in all neo-valves.
CONCLUSIONS
Trileaflet semilunar valve reconstruction is sufficient and non-stenotic. It resulted in an increased coaptation length and a windmill shape, which is speculated to decrease with the growth of the patient, yet remains sufficient as a transitional procedure until a long-term solution is feasible. Further in vivo investigations are warranted.
Topics: Animals; Aortic Valve; Echocardiography; Heart Valve Prosthesis; Heart Ventricles; Humans; Pulmonary Valve; Swine
PubMed: 36066430
DOI: 10.1093/icvts/ivac227 -
JACC. Cardiovascular Interventions Jan 2024Transcatheter pulmonary valve replacement (TPVR) has expanded and evolved since its initial commercial approval in the United States in 2010.
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.
Topics: Adult; Humans; Child; Young Adult; Heart Valve Prosthesis; Pulmonary Valve; Transcatheter Aortic Valve Replacement; Treatment Outcome; Registries
PubMed: 38267137
DOI: 10.1016/j.jcin.2023.10.065 -
International Journal of Cardiology Feb 2023
Topics: Humans; Pulmonary Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Treatment Outcome; Cardiac Catheterization; Prosthesis Design; Pulmonary Valve Insufficiency
PubMed: 36529307
DOI: 10.1016/j.ijcard.2022.12.024 -
Journal of the American College of... May 2023
Topics: Humans; Pulmonary Valve; Tetralogy of Fallot; Cardiac Surgical Procedures
PubMed: 37225361
DOI: 10.1016/j.jacc.2023.04.005 -
Interactive Cardiovascular and Thoracic... Apr 2021Many surgeons develop unique techniques for unmet needs for right ventricular outflow reconstruction to resolve pulmonary regurgitation after corrective surgery for... (Review)
Review
OBJECTIVES
Many surgeons develop unique techniques for unmet needs for right ventricular outflow reconstruction to resolve pulmonary regurgitation after corrective surgery for congenital heart diseases. Expanded polytetrafluoroethylene (ePTFE) stands out as a reliable synthetic material, and clinical results with handmade ePTFE valves have been promising. This review focuses on the historical evolution of the use of ePTFE in pulmonary valve replacement and in the techniques for pioneering the translation of the handmade ePTFE trileaflet design for the transcatheter approach.
METHODS
We searched for and reviewed publications from 1990 to 2020 in the Pubmed database. Nineteen clinical studies from 2005 to 2019 that focused on ePTFE-based valves were summarized. The evolution of the ePTFE-based valve over 3 decades and recent relevant in vitro studies were investigated.
RESULTS
The average freedom from reintervention or surgery in the recorded ePTFE-based valve population was 90.2% at 5 years, and the survival rate was 96.7% at 3 years.
CONCLUSIONS
Non-inferior clinical results of this ePTFE handmade valve were revealed compared to allograft or xenograft options for pulmonary valve replacement. Future investigations on transferring ePTFE trileaflet design to transcatheter devices should be considered.
Topics: Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Polytetrafluoroethylene; Prosthesis Design; Pulmonary Valve; Treatment Outcome
PubMed: 33377488
DOI: 10.1093/icvts/ivaa302