BACKGROUND: Percutaneous pulmonary valve implantation (PPVI) has been established as a safe and effective alternative to surgery treating patients with a failing pulmonary valve conduit. Nevertheless, the majority of patients in need of a valve have a native, non-obstructive right ventricular outflow tract (RVOT). The current approved stent-valves have a balloon-expandable design. Pre-stenting of the RVOT to create a landing zone and also protect the valve stability is usually mandatory; large, non-obstructive RVOTs need pre-stenting to reduce the RVOT-diameter for a balloon-expandable valve implantation. METHODS: A retrospective study design was used to analyze the medium-term outcome after PPVI in a series of 26 patients with native or reconstructed RVOT. RESULTS: PPVI was successfully performed in all, but 1 (96%). Within the follow-up of a minimum of 2 years, the percutaneous implanted valves remained competent; a significant pressure gradient was not detected. Furthermore, no PPVI-related complications such as endocarditis, migration or stent fractures were observed. The electrocardiogram at rest, in particular the QRS duration remained unchanged immediate post-PPVI as well as at medium-term follow-up of 24 months. However, ventricular arrhythmias were documented in 3 patients (11.5%); all patients were successfully treated with antiarrhythmic drugs, utilizing metoprolol. A trial of an invasive catheter based RVOT-ablation in one remained unsuccessful; pre-stented RVOT did not allow a successful intervention. CONCLUSIONS: Medium-term follow-up showed excellent results of the mechanical valve function. PPVI utilizing balloon-expandable stent-valves in a native RVOT remains an off-label use. Despite our encouraging results, advanced manipulations of the patched or native RVOT might be associated with significant ventricular arrhythmias. There is a need for less invasive RVOT reduction devices.
BACKGROUND: Percutaneous pulmonary valve implantation (PPVI) has been established as a safe and effective alternative to surgery treating patients with a failing pulmonary valve conduit. Nevertheless, the majority of patients in need of a valve have a native, non-obstructive right ventricular outflow tract (RVOT). The current approved stent-valves have a balloon-expandable design. Pre-stenting of the RVOT to create a landing zone and also protect the valve stability is usually mandatory; large, non-obstructive RVOTs need pre-stenting to reduce the RVOT-diameter for a balloon-expandable valve implantation. METHODS: A retrospective study design was used to analyze the medium-term outcome after PPVI in a series of 26 patients with native or reconstructed RVOT. RESULTS: PPVI was successfully performed in all, but 1 (96%). Within the follow-up of a minimum of 2 years, the percutaneous implanted valves remained competent; a significant pressure gradient was not detected. Furthermore, no PPVI-related complications such as endocarditis, migration or stent fractures were observed. The electrocardiogram at rest, in particular the QRS duration remained unchanged immediate post-PPVI as well as at medium-term follow-up of 24 months. However, ventricular arrhythmias were documented in 3 patients (11.5%); all patients were successfully treated with antiarrhythmic drugs, utilizing metoprolol. A trial of an invasive catheter based RVOT-ablation in one remained unsuccessful; pre-stented RVOT did not allow a successful intervention. CONCLUSIONS: Medium-term follow-up showed excellent results of the mechanical valve function. PPVI utilizing balloon-expandable stent-valves in a native RVOT remains an off-label use. Despite our encouraging results, advanced manipulations of the patched or native RVOT might be associated with significant ventricular arrhythmias. There is a need for less invasive RVOT reduction devices.
Authors: Andreas Eicken; Peter Ewert; Alfred Hager; Bjoern Peters; Sohrab Fratz; Titus Kuehne; Raymonde Busch; John Hess; Felix Berger Journal: Eur Heart J Date: 2011-01-27 Impact factor: 29.983
Authors: Doff B McElhinney; John P Cheatham; Thomas K Jones; James E Lock; Julie A Vincent; Evan M Zahn; William E Hellenbrand Journal: Circ Cardiovasc Interv Date: 2011-11-09 Impact factor: 6.546
Authors: Helmut Baumgartner; Philipp Bonhoeffer; Natasja M S De Groot; Fokko de Haan; John Erik Deanfield; Nazzareno Galie; Michael A Gatzoulis; Christa Gohlke-Baerwolf; Harald Kaemmerer; Philip Kilner; Folkert Meijboom; Barbara J M Mulder; Erwin Oechslin; Jose M Oliver; Alain Serraf; Andras Szatmari; Erik Thaulow; Pascal R Vouhe; Edmond Walma Journal: Eur Heart J Date: 2010-08-27 Impact factor: 29.983
Authors: P Bonhoeffer; Y Boudjemline; Z Saliba; J Merckx; Y Aggoun; D Bonnet; P Acar; J Le Bidois; D Sidi; J Kachaner Journal: Lancet Date: 2000-10-21 Impact factor: 79.321
Authors: Hamad F Al Habib; Jeffrey Phillip Jacobs; Constantine Mavroudis; Christo I Tchervenkov; Sean M O'Brien; Siamak Mohammadi; Marshall L Jacobs Journal: Ann Thorac Surg Date: 2010-09 Impact factor: 4.330
Authors: M A Gatzoulis; S Balaji; S A Webber; S C Siu; J S Hokanson; C Poile; M Rosenthal; M Nakazawa; J H Moller; P C Gillette; G D Webb; A N Redington Journal: Lancet Date: 2000-09-16 Impact factor: 79.321
Authors: Silvia Schievano; Louise Coats; Francesco Migliavacca; Wendy Norman; Alessandra Frigiola; John Deanfield; Philipp Bonhoeffer; Andrew M Taylor Journal: J Cardiovasc Magn Reson Date: 2007 Impact factor: 5.364
Authors: J G J Neffke; I I Tulevski; E E van der Wall; A A M Wilde; D J van Veldhuisen; A Dodge-Khatami; B J M Mulder Journal: Heart Date: 2002-09 Impact factor: 5.994