Percutaneous Pulmonary Valve Implantation

Author:

Lurz Philipp1,Coats Louise1,Khambadkone Sachin1,Nordmeyer Johannes1,Boudjemline Younes1,Schievano Silvia1,Muthurangu Vivek1,Lee Twin Yen1,Parenzan Giovanni1,Derrick Graham1,Cullen Seamus1,Walker Fiona1,Tsang Victor1,Deanfield John1,Taylor Andrew M.1,Bonhoeffer Philipp1

Affiliation:

1. 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.

Abstract

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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