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Journal of the American Heart... Aug 2017Transcatheter pulmonary valve implantation is approved for the treatment of dysfunctional right ventricle to pulmonary artery conduits. However, the literature is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Transcatheter pulmonary valve implantation is approved for the treatment of dysfunctional right ventricle to pulmonary artery conduits. However, the literature is limited because of a small patient population, and it does not reflect changing procedural practice patterns over the last decade.
METHODS AND RESULTS
A comprehensive search of Medline and Scopus databases from inception through August 31, 2016 was conducted using predefined criteria. We included studies reporting transcatheter pulmonary valve implantation in at least 5 patients with a follow-up duration of 6 months or more. In 19 eligible studies, 1044 patients underwent transcatheter pulmonary valve implantation with a pooled follow-up of 2271 person-years. Procedural success rate was 96.2% (95% confidence intervals [CI], 94.6-97.4) with a conduit rupture rate of 4.1% (95% CI, 2.5-6.8) and coronary complication rate of 1.3% (95% CI, 0.7-2.3). Incidence of reintervention was 4.4 per 100 person-years overall (95% CI, 3.0-5.9) with a marked reduction in studies reporting ≥75% prestenting (2.9 per 100 person-years [95% CI, 1.5-4.3] versus 6.5/100 person-years [95% CI, 4.6-8.5]; <0.01). Pooled endocarditis rate was 1.4 per 100 person-years (95% CI, 0.9-2.0).
CONCLUSIONS
Our study provides favorable updated estimates of procedural and follow-up outcomes after transcatheter pulmonary valve implantation. Widespread adoption of prestenting has improved longer-term outcomes in these patients.
Topics: Adolescent; Adult; Cardiac Catheterization; Child; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Observational Studies as Topic; Postoperative Complications; Pulmonary Valve; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 28778940
DOI: 10.1161/JAHA.117.006432 -
Archives of Cardiovascular Diseases Nov 2014Since the first transcatheter implantation of a pulmonary valve in 2000 in a twelve year-old boy with a dysfunctional right ventricle to pulmonary artery conduit by... (Review)
Review
Since the first transcatheter implantation of a pulmonary valve in 2000 in a twelve year-old boy with a dysfunctional right ventricle to pulmonary artery conduit by Philip Bonhoeffer and Younes Boudjemline, the Melody(®) valve has become worldwide used. It represents an efficient alternative to open-heart surgery. We aimed in this comprehensive review to describe the current indications of percutaneous pulmonary valve implantation, the devices currently used and the clinical results.
Topics: Bioprosthesis; Cardiac Catheterization; Heart Defects, Congenital; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Prosthesis Design; Prosthesis Failure; Pulmonary Valve; Pulmonary Valve Insufficiency; Pulmonary Valve Stenosis; Treatment Outcome
PubMed: 25444020
DOI: 10.1016/j.acvd.2014.07.048 -
The Journal of Thoracic and... Sep 2021
Review
Topics: Cardiac Catheterization; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Pulmonary Valve; Recovery of Function; Treatment Outcome; Ventricular Function, Right
PubMed: 33097216
DOI: 10.1016/j.jtcvs.2020.07.126 -
Journal of the American College of... Mar 2020
Topics: Adult; Cardiac Surgical Procedures; Heart Defects, Congenital; Humans; Pulmonary Valve; Tricuspid Valve
PubMed: 32138964
DOI: 10.1016/j.jacc.2020.01.006 -
Journal of the American College of... Oct 2016
Topics: Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 27687195
DOI: 10.1016/j.jacc.2016.08.001 -
Journal of Cardiac Surgery Dec 2022Tetralogy of Fallot (TOF) repair is a frequent procedure, and although valve-sparing (VS) repair is preferred, determining which patients can successfully undergo this... (Review)
Review
BACKGROUND
Tetralogy of Fallot (TOF) repair is a frequent procedure, and although valve-sparing (VS) repair is preferred, determining which patients can successfully undergo this operation remains controversial. We sought to identify parameters to determine a selective, accurate indication for VS repair.
METHODS
We reviewed 71 patients (82%) undergoing VS repair. We analyzed hemodynamic data, intraoperative reports, and follow-up echocardiography results to identify acceptable indications. Patients requiring pulmonary valve (PV) reintervention versus no reintervention were compared.
RESULTS
PV annulus size at repair was z-score of -2.0 (-5.3, 1.3). Approximately half (51%) had a z-score less than -2. Cox regression results showed this was not a risk factor for reintervention (p = .59). Overall, 1-, 3-, 5-, and 10-year freedom from PV reintervention rates were 95.8%, 92.8%, 91% and 77.8%, respectively. Residual pulmonary stenosis (PS) at initial repair was relatively higher in the reintervention group compared with no reintervention group (40 [28, 51] mmHg vs. 30 [22, 37] mmHg; p = .08). For patients with residual PS, pressure gradient (PG) was consistent over time across both groups (PV reintervention: -3 [-15, 8] mmHg vs. no reintervention: 0 [-9, 8] mmHg). The risk of PV reintervention is 3.7-fold higher when the PG from intraoperative TEE is greater than 45 mmHg (p = .04).
CONCLUSIONS
Our review of the midterm outcomes of expanded indication for VS suggests intraoperative decision to convert to transannular patch is warranted if intraoperative postprocedure TEE PG is greater than 45 mmHg or RV pressure is higher than half of systemic pressure to prevent reintervention.
Topics: Humans; Infant; Pulmonary Valve; Tetralogy of Fallot; Cardiac Surgical Procedures; Treatment Outcome; Pulmonary Valve Stenosis; Retrospective Studies
PubMed: 36378940
DOI: 10.1111/jocs.17156 -
The Journal of Thoracic and... Jan 2019
Topics: Aortic Valve; Autografts; Pulmonary Valve
PubMed: 30100491
DOI: 10.1016/j.jtcvs.2018.06.051 -
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 -
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 Sep 2017
Topics: Heart Valve Prosthesis; Humans; Prospective Studies; Pulmonary Valve; Pulmonary Valve Insufficiency; Stents; United States
PubMed: 28823779
DOI: 10.1016/j.jcin.2017.06.008