Athar M Qureshi1, Neha Bansal2, Doff B McElhinney3, Younes Boudjemline4, Tom J Forbes2, Nicola Maschietto5, Shabana Shahanavaz6, John P Cheatham7, Richard Krasuski8, Luke Lamers9, Massimo Chessa10, Brian H Morray11, Bryan H Goldstein12, Cory V Noel13, Yunfei Wang13, Matthew J Gillespie14. 1. The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Center of Pediatric and Congenital Heart Disease, Cleveland Clinic Children's and Pediatric Institute, The Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart and Vascular Institute, The Cleveland Clinic, Cleveland, Ohio. Electronic address: axquresh@texaschildrens.org. 2. Division of Pediatric Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan. 3. Departments of Pediatrics and Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center, Stanford University School of Medicine, Palo Alto, California. 4. Department of Paediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Paris, France. 5. Pediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, Padova, Italy. 6. Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri. 7. Center, Nationwide Children's Hospital, Columbus, Ohio. 8. Department of Cardiovascular Medicine, Heart and Vascular Institute, The Cleveland Clinic, Cleveland, Ohio; Division of Cardiology, Duke University Medical Center, Durham, North Carolina. 9. American Family Children's Hospital, Madison, Wisconsin. 10. Pediatric and Adult Congenital Heart Center, IRCCS-Policlinico San Donato-University Hospital, Milan, Italy. 11. Division of Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington. 12. The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine; Cincinnati, Ohio. 13. The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas. 14. The Cardiac Center at the Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Abstract
OBJECTIVES: The authors sought to assess the intermediate-term effects of percutaneous placed valves in the branch pulmonary artery (PA) position. BACKGROUND: Most patients with large right ventricular outflow tracts (RVOTs) are excluded from available percutaneous pulmonary valve options. In some of these patients, percutaneous branch PA valve implantation may be feasible. The longer-term effects of valves in the branch PA position is unknown. METHODS: Retrospective data were collected on patients with significant pulmonary regurgitation who had a percutaneous branch PA valve attempted. RESULTS: Percutaneous branch PA valve implantation was attempted in 34 patients (18 bilateral and 16 unilateral). One-half of the patients were in New York Heart Association (NHYA) functional class III or IV pre-implantation. There were 2 failed attempts and 6 procedural complications. At follow-up, only 1 patient had more than mild valvar regurgitation. The right ventricular end-diastolic volume index decreased from 147 (range: 103 to 478) ml/m2 to 101 (range: 76 to 429) ml/m2, p < 0.01 (n = 16), and the right ventricular end-systolic volume index decreased from 88.5 (range: 41 to 387) ml/m2 to 55.5 (range: 40.2 to 347) ml/m2, p < 0.01 (n = 13). There were 5 late deaths. At a median follow-up of 2 years, all other patients were in NYHA functional class I or II. CONCLUSIONS: Percutaneous branch PA valve implantation results in a reduction in right ventricular volume with clinical benefit in the intermediate term. Until percutaneous valve technology for large RVOTs is refined and more widely available, branch PA valve implantation remains an option for select patients.
OBJECTIVES: The authors sought to assess the intermediate-term effects of percutaneous placed valves in the branch pulmonary artery (PA) position. BACKGROUND: Most patients with large right ventricular outflow tracts (RVOTs) are excluded from available percutaneous pulmonary valve options. In some of these patients, percutaneous branch PA valve implantation may be feasible. The longer-term effects of valves in the branch PA position is unknown. METHODS: Retrospective data were collected on patients with significant pulmonary regurgitation who had a percutaneous branch PA valve attempted. RESULTS: Percutaneous branch PA valve implantation was attempted in 34 patients (18 bilateral and 16 unilateral). One-half of the patients were in New York Heart Association (NHYA) functional class III or IV pre-implantation. There were 2 failed attempts and 6 procedural complications. At follow-up, only 1 patient had more than mild valvar regurgitation. The right ventricular end-diastolic volume index decreased from 147 (range: 103 to 478) ml/m2 to 101 (range: 76 to 429) ml/m2, p < 0.01 (n = 16), and the right ventricular end-systolic volume index decreased from 88.5 (range: 41 to 387) ml/m2 to 55.5 (range: 40.2 to 347) ml/m2, p < 0.01 (n = 13). There were 5 late deaths. At a median follow-up of 2 years, all other patients were in NYHA functional class I or II. CONCLUSIONS: Percutaneous branch PA valve implantation results in a reduction in right ventricular volume with clinical benefit in the intermediate term. Until percutaneous valve technology for large RVOTs is refined and more widely available, branch PA valve implantation remains an option for select patients.
Authors: Norihiko Kamioka; Vasilis C Babaliaros; John C Lisko; Anurag Sahu; Subhadra Shashidharan; Matthew R Carazo; Maan Jokhadar; Fred H Rodriguez; Wendy M Book; Patrick T Gleason; William B Keeling; Wissam Jaber; Peter C Block; Robert J Lederman; Adam B Greenbaum; Dennis W Kim Journal: JACC Cardiovasc Interv Date: 2020-12-14 Impact factor: 11.195