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Published Online
on April 7, 2008

Circulation. 2008
Published online before print April 7, 2008, doi: 10.1161/CIRCULATIONAHA.107.735779
A more recent version of this article appeared on April 15, 2008
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Submitted on August 23, 2007
Accepted on February 15, 2008

Percutaneous Pulmonary Valve Implantation. Impact of Evolving Technology and Learning Curve on Clinical Outcome

Philipp Lurz BSc, Louise Coats MRCP, Sachin Khambadkone MD, MRCP, Johannes Nordmeyer MD, Younes Boudjemline MD, Silvia Schievano MEng, Vivek Muthurangu MRCP, Twin Yen Lee RN, Giovanni Parenzan MA, Graham Derrick MRCP, Seamus Cullen MRCPI, Fiona Walker MRCP, Victor Tsang MD, FRCS, John Deanfield FRCP, Andrew M. Taylor MD, MRCP, FRCR, and Philipp Bonhoeffer MD*

From the UCL Institute of Child Health (P.L., L.C., S.K., J.N., S.S., V.M., G.D., S.C., V.T., J.D., A.M.T., P.B.), London, United Kingdom; Great Ormond Street Hospital for Children NHS Trust (P.L., L.C., S.K., J.N., S.S., V.M., T.Y.L., G.P., G.D., V.T., J.D., A.M.T., P.B.), Cardiothoracic Unit, London, United Kingdom; Service de Cardiologie Pédiatrique (Y.B.), Hôspital Necker Enfants Malades, Paris, France; and The Heart Hospital NHS Trust (S.C., F.W., V.T., J.D., P.B.), London, United Kingdom.

* To whom correspondence should be addressed. E-mail: BonhoP{at}gosh.nhs.uk.

Background—Percutaneous pulmonary valve implantation was introduced in the year 2000 as a nonsurgical treatment for patients with right ventricular outflow tract dysfunction.

Methods and Results—Between September 2000 and February 2007, 155 patients with stenosis and/or regurgitation underwent percutaneous pulmonary valve implantation. This led to significant reduction in right ventricular systolic pressure (from 63±18 to 45±13 mm Hg, P<0.001) and right ventricular outflow tract gradient (from 37±20 to 17±10 mm Hg, P<0.001). Follow-up ranged from 0 to 83.7 months (median 28.4 months). Freedom from reoperation was 93% (±2%), 86% (±3%), 84% (±4%), and 70% (±13%) at 10, 30, 50, and 70 months, respectively. Freedom from transcatheter reintervention was 95% (±2%), 87% (±3%), 73% (±6%), and 73% (±6%) at 10, 30, 50, and 70 months, respectively. Survival at 83 months was 96.9%. On time-dependent analysis, the first series of 50 patients (log-rank test P<0.001) and patients with a residual gradient >25 mm Hg (log-rank test P=0.01) were associated with a higher risk of reoperations.

Conclusions—Percutaneous pulmonary valve implantation resulted in the ability to avoid surgical right ventricular outflow tract revision in the majority of cases. This procedure might reduce the number of operations needed over the total lifetime of patients with right ventricle–to–pulmonary artery conduits.


Key words: pulmonary valve • heart defects, congenital • catheterization • stenosis • regurgitation


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Clinical Summaries
Circulation 2008 117: 1909. [Full Text]