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European Journal of Cardio-thoracic... Apr 2021Hybrid approach to pulmonary valve replacement (PVR) in the paediatric population has been reported, although data in infants and small children are limited. Several...
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.
Topics: Cardiac Catheterization; Cardiac Surgical Procedures; Child; Follow-Up Studies; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Infant; Pulmonary Valve; Pulmonary Valve Insufficiency; Retrospective Studies; Treatment Outcome
PubMed: 33253364
DOI: 10.1093/ejcts/ezaa410 -
Arquivos Brasileiros de Cardiologia Oct 2021
Topics: Echocardiography; Heart Ventricles; Humans; Pulmonary Valve Insufficiency
PubMed: 34709297
DOI: 10.36660/abc.20210744 -
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 -
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 -
Seminars in Thoracic and Cardiovascular... 2015An increasing number of patients with congenital heart disease are surviving into adulthood, and many will require repeat surgical intervention. Those patients with... (Review)
Review
An increasing number of patients with congenital heart disease are surviving into adulthood, and many will require repeat surgical intervention. Those patients with tetralogy of Fallot likely represent the largest group. Of the clinically important complications that affect adults with repaired tetralogy of Fallot, pulmonary regurgitation is the most common. Without intervention, pulmonary regurgitation results in dilation of the right ventricle and may lead to additional complications, such as biventricular dysfunction, arrhythmias, heart failure, and death. Pulmonary valve replacement (PVR) is a means to ameliorate these adverse sequelae and is the most common reoperation performed in adults with congenital heart disease. Although still controversial, much has been written on the indications for and timing of PVR. This article examines some of the less-reported issues surrounding PVR in repaired tetralogy of Fallot, including contemporary surgical outcomes, the role of the percutaneous and mechanical valve, and the role of concomitant aortic and tricuspid operations during PVR.
Topics: Adult; Cardiac Surgical Procedures; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Reoperation; Tetralogy of Fallot
PubMed: 26074110
DOI: 10.1053/j.semtcvs.2015.02.010 -
The Annals of Thoracic Surgery Sep 2020A percutaneous approach for pulmonary valve replacement (PVR) is a feasible alternative to surgical PVR in selected patients with severe pulmonary regurgitation after... (Observational Study)
Observational Study
BACKGROUND
A percutaneous approach for pulmonary valve replacement (PVR) is a feasible alternative to surgical PVR in selected patients with severe pulmonary regurgitation after repair of tetralogy of Fallot. However, large right ventricular outflow tract (diameter ≥ 25 mm) remains challenging.
METHODS
This retrospective multicenter study enrolled consecutive patients with large right ventricular outflow tract who underwent percutaneous PVR (Venus P-valve, Venus MedTech Inc, Hangzhou, China) (n = 35) or surgical PVR (homograft valve; n = 30) between May 2014 and April 2017. Patients were followed up at 1, 3, 6, and 12 months, and yearly thereafter. Main study outcomes were pulmonary valve function and right ventricular function at discharge and midterm follow-up.
RESULTS
PVR was successful in all patients. Percutaneous compared with surgical PVR group had: similarly distributed baseline characteristics; shorter hospitalization, intensive care unit stay, and endotracheal intubation duration; lower cost; lower pulmonary valve gradient before discharge; lower pulmonary valve regurgitant grade (mean difference, -0.63; 95% CI -1.11 to -0.20, P = .022), pulmonary valve gradient (mean difference, -5.7 mm Hg; 95% CI -9.4 to -2.2 mm Hg, P = .005), and right ventricular end-diastolic volume index (mean difference, -9.5 mL/m; 95% CI -16.9 to -3.1 mL/m, P = .022); and greater right ventricular ejection fraction (mean difference, 5.4%; 95% CI 2.4%-8.3%, P = .002) at median 36 months follow-up, without deaths in either group.
CONCLUSIONS
Percutaneous PVR using Venus P-valve appeared to be a safe, efficacious and minimally invasive alternative to surgical PVR in selected patients with large right ventricular outflow tract yielding better right ventricular and pulmonary valve function at midterm follow-up.
Topics: Adult; Cardiac Catheterization; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation; Heart Ventricles; Humans; Magnetic Resonance Imaging, Cine; Male; Pulmonary Valve; Pulmonary Valve Insufficiency; Retrospective Studies; Stroke Volume; Ventricular Function, Right
PubMed: 32087135
DOI: 10.1016/j.athoracsur.2020.01.009 -
The Canadian Journal of Cardiology Dec 2019
Topics: Adult; Canada; Evidence-Based Medicine; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Tetralogy of Fallot; Writing
PubMed: 31813497
DOI: 10.1016/j.cjca.2019.10.005 -
The Annals of Thoracic Surgery Jun 2016Pulmonary valve (PV) insufficiency is often an acquired condition after treatment for pulmonary stenosis. It is recognized that PV insufficiency has serious deleterious...
BACKGROUND
Pulmonary valve (PV) insufficiency is often an acquired condition after treatment for pulmonary stenosis. It is recognized that PV insufficiency has serious deleterious effects. Although surgical replacement of the PV is efficacious, artificial valves inevitably fail and require re-intervention. The purpose of this study was to summarize our experience with PV repair in patients with acquired PV insufficiency.
METHODS
This was a retrospective review of 16 patients with marked PV insufficiency who underwent PV repair. Thirteen of these patients were born with tetralogy of Fallot (TOF) and had undergone a previous transannular patch repair. Three patients were born with critical pulmonary stenosis and had a surgical valvotomy or balloon valvuloplasty.
RESULTS
The 13 patients with TOF had resection of their previously placed transannular patch with re-approximation of the anterior commissure. All 13 patients experienced a marked reduction in the degree of pulmonary insufficiency. None of these patients have experienced any increase in insufficiency during follow-up. The 3 patients with critical pulmonary stenosis had a variety of pathologic findings identified at the surgical procedure. One patient had a large gap between a commissure and underwent closure of that commissure. The second and third patients had torn leaflets repaired with pericardial and Gore-Tex patches (Gore, Inc, Flagstaff, AZ). The degree of PV insufficiency was decreased to mild in all 3 patients. However, 2 of these 3 patients have subsequently had an increase in the degree of pulmonary insufficiency.
CONCLUSIONS
Patients with TOF who underwent a previous transannular patch may be candidates for bicuspidization of their native PV, and the results of this procedure have been quite stable at follow-up. PV repair for torn leaflets was effective in the short term but was less stable over time.
Topics: Angioplasty, Balloon; Bioprosthesis; Cardiopulmonary Bypass; Echocardiography, Transesophageal; Heart Valve Prosthesis Implantation; Humans; Polytetrafluoroethylene; Postoperative Complications; Pulmonary Valve; Pulmonary Valve Insufficiency; Pulmonary Valve Stenosis; Reoperation; Retrospective Studies; Tetralogy of Fallot; Treatment Outcome
PubMed: 27083251
DOI: 10.1016/j.athoracsur.2016.01.035 -
Journal of the American College of... Dec 2018Endocarditis has emerged as one of the most concerning adverse outcomes in patients with congenital anomalies involving the right ventricular outflow tract (RVOT) and... (Clinical Trial)
Clinical Trial
BACKGROUND
Endocarditis has emerged as one of the most concerning adverse outcomes in patients with congenital anomalies involving the right ventricular outflow tract (RVOT) and prosthetic valves.
OBJECTIVES
The aim of this study was to evaluate rates and potential risk factors for endocarditis after transcatheter pulmonary valve replacement in the prospective Melody valve trials.
METHODS
All patients in whom a transcatheter pulmonary valve (TPV) was implanted in the RVOT as part of 3 prospective multicenter studies comprised the analytic cohort. The diagnosis of endocarditis and involvement of the TPV were determined by the implanting investigator.
RESULTS
A total of 309 patients underwent transcatheter pulmonary valve replacement (TPVR) and were discharged with a valve in place. The median follow-up duration was 5.1 years, and total observation until study exit was 1,660.3 patient-years. Endocarditis was diagnosed in 46 patients (median 3.1 years after TPVR), and a total of 35 patients were reported to have TPV-related endocarditis (34 at the initial diagnosis, 1 with a second episode). The annualized incidence rate of endocarditis was 3.1% per patient-year and of TPV-related endocarditis was 2.4% per patient-year. At 5 years post-TPVR, freedom from a diagnosis of endocarditis was 89% and freedom from TPV-related endocarditis was 92%. By multivariable analysis, age ≤12 years at implant (hazard ratio: 2.3; 95% confidence interval: 1.2 to 4.4; p = 0.011) and immediate post-implant peak gradient ≥15 mm Hg (2.7; 95% confidence interval: 1.4 to 4.9; p = 0.002) were associated with development of endocarditis and with development of TPV-related endocarditis (age ≤12 years: 2.8; 95% confidence interval: 1.3 to 5.7; p = 0.006; gradient ≥15 mm Hg: 2.6; 95% confidence interval: 1.3 to 5.2; p = 0.008).
CONCLUSIONS
Endocarditis is an important adverse outcome following TVPR in children and adults with post-operative congenital heart disease involving the RVOT. Ongoing efforts to understand, prevent, and optimize management of this complication are paramount in making the best use of TPV therapy. (Melody Transcatheter Pulmonary Valve [TPV] Study: Post Approval Study of the Original Investigational Device Exemption [IDE] Cohort; NCT00740870; Melody Transcatheter Pulmonary Valve Post-Approval Study; NCT01186692; and Melody Transcatheter Pulmonary Valve [TPV] Post-Market Surveillance Study; NCT00688571).
Topics: Adolescent; Adult; Child; Endocarditis, Bacterial; Equipment Contamination; Female; Follow-Up Studies; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Pulmonary Valve; Pulmonary Valve Insufficiency; Young Adult
PubMed: 30497557
DOI: 10.1016/j.jacc.2018.09.039 -
Cardiology in the Young Dec 2014Pulmonary valve replacement in patients with congenital cardiac disease is now being performed with more liberal indications in light of the data that chronic pulmonary...
Pulmonary valve replacement in patients with congenital cardiac disease is now being performed with more liberal indications in light of the data that chronic pulmonary insufficiency is not a benign lesion. The beneficial effects of valve replacement with low operative mortality and morbidity support this approach. Many options exist for a pulmonary valve prosthesis, which underscores the fact that there is no ideal valve available. Our efforts are focussed around a synthetic valve that avoids the bio-degeneration of a bio-prosthesis and avoids the need for life-long coumadin. We developed a bicuspid (bileaflet) polytetrafluoroethylene valve design, which has now gone through three major revisions in >200 patients over 14 years. We began the experience utilising a polytetrafluoroethylene hand-sewn bicuspid valve in the right ventricular outflow tract, initially using 0.6 mm and more recently 0.1 mm polytetrafluoroethylene. The 0.1 mm thickness material functions well as a leaflet, maintaining a relatively thin and flexible nature. It does not calcify or initiate thromboses at least for the first several years. We identified issues with dehiscence of the leaflet from the right ventricular outflow tract muscle, especially in the larger, potentially expansive right ventricular outflow tracts, and this prompted our latest design change to place the valve within a polytetrafluoroethylene tube. This current version of the polytetrafluoroethylene valve conduit has excellent short-to-intermediate-term function. Further follow-up is necessary to determine late durability and life-long valve-related procedural risk for our patients.
Topics: Chronic Disease; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Polytetrafluoroethylene; Prosthesis Design; Pulmonary Valve Insufficiency
PubMed: 25647385
DOI: 10.1017/S1047951114002200