Abstract 2348: Percutaneous Pulmonary Valve Replacement: Indications and Clinical Characteristics of Patients with Repaired Complex Congenital Heart Disease
Percutaneous heart valve replacement (PHVR) can be used to treat pulmonary stenosis/regurgitation in the adult congenital heart disease (ACHD) population. PHVR may be recommended earlier than conventional surgery, but the indications are unclear. In an effort to develop referral guidelines, we reviewed the charts of all patients with complex ACHD and RV to PA conduits followed at our provincial clinic. (n=52, age 28±9.2yrs) Tetraology of Fallot was the most common congenital lesion (n=27), and the average patient age and conduit size at the 1st conduit procedure was 9±9.7yrs and 18±4.6mm, respectively. 67% required a second conduit (23±3.5mm) within 9±5.3yrs. Some have required multiple conduit revisions (3rd revision (n=16), 4th revision (n=1)). 25 patients had conduit revisions between ages 10 and 14. Of the 25, 13 needed conduit revision after 7±4yrs of follow-up (conduit size: 21±5.3mm). Of the 25 patients ≥ 15 years old at the time of their last conduit revision (conduit size 26±2.8mm), none have had further revision after a mean follow-up of 7±4.3 years. With respect to all 52 patients, they are currently 10±6.3yrs since their last revision. 31% have mild-mod RV dysfunction with 27, 8, and 25% having outflow obstruction, PR or both (respectively). Using the criteria suggested Bonhoeffer et al., and with conduits of appropriate size for the Edwards Life Sciences PHV (23 or 26mm), we found only 17% of patients to be potentially eligible for PHVR. The reasons for exclusion were: 21 patients with too large/small conduits, 2 lost to follow-up, 2 to surgery for other reasons, and 19 lacked hemodynamic indications for revision. Of the 9 potentially eligible: 1 has had a successful PHV procedure, 2 further procedures are pending, 2 were excluded for technical reasons, and 3 patients are being brought back for further consideration. The overall prevalence of potentially eligible patients was lower than expected. The published literature and general guidelines suggest the average life span of a homograft conduit is 10 years. Our data suggest larger conduits placed during adolescence may last longer than 10 years, especially when the conduits are of large diameter. The addition of larger PHV devices may increase the number of patients that can be treated with this technology.