Abstract 12657: Transcatheter Pulmonary Valve Implantation - Results in 25 Patients
Purpose: To assess the results of transcatheter pulmonary valve implantation (TPVI) in pts with pulmonary conduits and patched right ventricular outflow tract (RVOT).
Methods: TPVI with routine pre-stenting with bare metal stent was performed in 25 pts (mean age 23.9±8.5 years, 15 males)after total repair of tetralogy of Fallot (n=9), pulmonary atresia (n=8), Ross procedure (n=4) and other defects (n=4). RVOT reconstruction was done using pulmonary homograft (n=19), Contegra xenograft (n=1), aortic homograft (n=2) or aortic monocusp valve (n=3). Melody Medtronic valve was implanted in 23 cases and Sapien-Edwards valve (23 and 26 mm) in 2 pts (pulmonary homograft - 1 pt, patched RVOT -1 pt) with a wide RVOT. Follow-up assessment comprised clinical evaluation, cardiac magnetic resonance, echocardiography and chest X-ray. 22 pts completed 1-month and 6-month, 15 pts one year and 6 pts 2 year follow-up.
Results: TPVI was performed with no early complications in 24 patients. In one case calcified aortic homograft was damaged during metal stent implantation. The patient was operated with good result. In 20 patients with significant pulmonary stenosis peak RVOT gradient was reduced from a mean of 89,6±37.1 mm Hg to 31,4±14.3 mm Hg on the next day after implantation (p<0.0001) and remained low at follow-up. The valve was competent in 20 pts, insignificant pulmonary regurgitation was seen in 5 pts. Relief of RVOT obstruction and restoration of pulmonary valve competence were associated with significant decrease in right ventricular end-diastolic and end-systolic volumes (133.3±44.5 mL/m2 vs 118.1±38.1 mL/m2; p=0.0013 and 74.1±38.3 mL/m2 vs 60.4±37 mL/m2; p=0.003, respectively)and New York Heart Association class improvement (p<0.05). The effect was stable in 21 pts during 6, 12 and 24 months. In one case postdilatation with a high pressure balloon was performed 2 months after the procedure. Infectious endocarditis was recognized 3 months after the procedure in 1 case; pharmacological therapy was efficient. No stent fractures were observed.
Conclusions: 1/ TPVI is a safe and effective method of treatment in patients with repaired. 2/ TPVI may be performed in selected pts with patched RVOT. 3/ Routine pre-stenting with BMS may protect against valved stent fractures.
- Adult congenital heart disease
- Valvular heart disease
- Heart valves
- Interventional cardiology
- Pulmonary valve
- © 2011 by American Heart Association, Inc.