Mary Hunt Martin1, Jeffery Meadows2, Doff B McElhinney3, Bryan H Goldstein4, Lisa Bergersen5, Athar M Qureshi6, Shabana Shahanavaz7, Jamil Aboulhosn8, Darren Berman9, Lynn Peng10, Matthew Gillespie11, Aimee Armstrong12, Cindy Weng13, L LuAnn Minich14, Robert G Gray14. 1. Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah. Electronic address: mary.hunt.martin@hsc.utah.edu. 2. Division of Cardiology, Department of Pediatrics, University of California San Francisco, San Francisco, California. 3. Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Palo Alto, California; Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, California. 4. Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio. 5. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts. 6. The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas. 7. Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri. 8. Division of Cardiology, Department of Pediatrics, University of California Los Angeles, Los Angeles, California. 9. Division of Cardiology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio. 10. Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Palo Alto, California. 11. Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 12. Division of Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, Michigan. 13. Department of Statistics, University of Utah, Salt Lake City, Utah. 14. Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
Abstract
OBJECTIVES: This study sought to determine the safety and feasibility of transcatheter pulmonary valve replacement (TPVR) using the Melody valve in native (nonconduit) right ventricular outflow tracts (nRVOT), and to identify factors associated with successful TPVR. BACKGROUND: The Melody valve is Food and Drug Administration-approved for TPVR within right ventricle-to-pulmonary artery conduits and bioprosthetic pulmonary valves. However, most patients needing pulmonary valve replacement have nRVOT and TPVR has been adapted for this indication. METHODS: In this multicenter retrospective study of all patients presenting for nRVOT TPVR, we collected pre-procedural magnetic resonance imaging, echocardiography, and catheterization data, and evaluated procedural and early outcomes. RESULTS: Of 229 patients (age 21 ± 15 years from 11 centers), 132 (58%) had successful TPVR. In the remaining 97, TPVR was not performed, most often because of prohibitively large nRVOT (n = 67) or compression of the aortic root or coronary arteries (n = 18). There were no deaths and 5 (4%) serious complications, including pre-stent embolization requiring surgery in 4 patients, and arrhythmia in 1. Higher pre-catheterization echocardiographic RVOT gradient was associated with TPVR success (p = 0.001) and larger center volume approached significance (p = 0.08). Magnetic resonance imaging anterior-posterior and lateral RVOT diameters were smaller in implanted versus nonimplanted patients (18.0 ± 3.6 mm vs. 20.1 ± 3.5 mm; p = 0.005; 18.4 ± 4.3 mm vs. 21.5 ± 3.8 mm; p = 0.002). CONCLUSIONS: TPVR in the nRVOT was feasible and safe. However, nearly half the patients presenting for catheterization did not undergo TPV implantation, mainly because of prohibitively large nRVOT size. Improved understanding of magnetic resonance imaging data and availability of larger devices may improve the success rate for nRVOT TPVR.
OBJECTIVES: This study sought to determine the safety and feasibility of transcatheter pulmonary valve replacement (TPVR) using the Melody valve in native (nonconduit) right ventricular outflow tracts (nRVOT), and to identify factors associated with successful TPVR. BACKGROUND: The Melody valve is Food and Drug Administration-approved for TPVR within right ventricle-to-pulmonary artery conduits and bioprosthetic pulmonary valves. However, most patients needing pulmonary valve replacement have nRVOT and TPVR has been adapted for this indication. METHODS: In this multicenter retrospective study of all patients presenting for nRVOT TPVR, we collected pre-procedural magnetic resonance imaging, echocardiography, and catheterization data, and evaluated procedural and early outcomes. RESULTS: Of 229 patients (age 21 ± 15 years from 11 centers), 132 (58%) had successful TPVR. In the remaining 97, TPVR was not performed, most often because of prohibitively large nRVOT (n = 67) or compression of the aortic root or coronary arteries (n = 18). There were no deaths and 5 (4%) serious complications, including pre-stent embolization requiring surgery in 4 patients, and arrhythmia in 1. Higher pre-catheterization echocardiographic RVOT gradient was associated with TPVR success (p = 0.001) and larger center volume approached significance (p = 0.08). Magnetic resonance imaging anterior-posterior and lateral RVOT diameters were smaller in implanted versus nonimplanted patients (18.0 ± 3.6 mm vs. 20.1 ± 3.5 mm; p = 0.005; 18.4 ± 4.3 mm vs. 21.5 ± 3.8 mm; p = 0.002). CONCLUSIONS: TPVR in the nRVOT was feasible and safe. However, nearly half the patients presenting for catheterization did not undergo TPV implantation, mainly because of prohibitively large nRVOT size. Improved understanding of magnetic resonance imaging data and availability of larger devices may improve the success rate for nRVOT TPVR.
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
Authors: Dietmar Boethig; Alexander Horke; Mark Hazekamp; Bart Meyns; Filip Rega; Joeri Van Puyvelde; Michael Hübler; Martin Schmiady; Anatol Ciubotaru; Giovanni Stellin; Massimo Padalino; Viktor Tsang; Ramadan Jashari; Dmitry Bobylev; Igor Tudorache; Serghei Cebotari; Axel Haverich; Samir Sarikouch Journal: Eur J Cardiothorac Surg Date: 2019-09-01 Impact factor: 4.191