Abstract 19011: Is It Necessary to Pre-Stent Right Ventricular Outflow Tract Prior to Percutaneous Pulmonary Valve Implantation in All Patients?
Background: Bare metal stent placement prior to Melody valve insertion (MVI) is common. We analyzed acute and short-term outcome following MVI with and without pre-stenting (PS) the conduit.
Methods: This is a retrospective single-center study. Patients (pts) were divided into two groups, with and without PS. The conduits were divided into homograft (HG) and valve with supporting ring (VSR) groups.
Results: From June 2010 to May 2013, 49 pts underwent MVI. Conduits were HG in 24 (49%) and VSR in 25 (51%). Primary indication was stenosis in 20 and regurgitation in 29 pts. PS was performed in 16 (33%) vs. no PS in 33 (67%) pts. Major procedural complication included conduit (HG) rupture requiring covered stent placement in 1 pt. In the entire cohort, baseline peak RVOT gradient at cath was 27.14 ± 14.55 vs. 14.82 ± 9.83 mmHg post-implantation (p < 0.0001). Baseline pulmonary regurgitation (PR) was moderate to severe in 36/40 (90%). Only 2 had moderate or greater PR post-implant. Freedom from Melody stent fracture was 95.83% (in 23/24) at 9.85 months and freedom from melody valve dysfunction was 93.7% (45/48) at median 16.5 months of follow up. The pre- and immediate post-implantation RVOT gradient (12.81 ± 14.14 mmHg vs. 12.09 ± 11.88 mmHg, p=0.852) and degree of PR were not significantly different between the PS and no PS group. At follow-up, Melody valve dysfunction and freedom from stent fracture were not significantly different between the groups. In pts with VSR, RVOT gradient post-implant was not significantly different between the PS and no PS groups; however pts with no PS showed a trend towards lower post-implant RVOT gradient (20.38 ± 10.72 vs. 12.76 ± 10.23, p=0.059). There were no VSR pts with stent fracture and only 1 had moderate PR on follow-up.
Conclusion: We demonstrated excellent procedural and short term success in all pts despite absence of pre-stenting in the majority of pts. Patients with VSR and no pre-stenting had better or comparable hemodynamic results and no stent fractures at short term follow-up. Pts with VSR may not require pre-stenting prior to MVI.
- © 2013 by American Heart Association, Inc.