Intentional Fracture of Bioprosthetic Valve Frames in Patients Undergoing Valve-in-Valve Transcatheter Pulmonary Valve Replacement.

Autor:	Shahanavaz S; Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, MO (S.S., D.T.B.)., Asnes JD; Yale University, New Haven, CT (J.D.A., W.H.)., Grohmann J; Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Germany (J.G.)., Qureshi AM; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston (A.M.Q.)., Rome JJ; The Children's Hospital of Philadelphia, PA (J.J.R., M.J.G.)., Tanase D; Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre, Munich (D.T.)., Crystal MA; Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY (M.A.C.)., Latson LA; Department of Cardiology, Joe DiMaggio Children's Hospital, Hollywood, FL (L.A.L.)., Morray BH; Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine (B.H.M.)., Hellenbrand W; Yale University, New Haven, CT (J.D.A., W.H.)., Balzer DT; Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, MO (S.S., D.T.B.)., Gewillig M; Department of Pediatric Cardiology, University Hospitals Leuven, Belgium (M.G.)., Love JC; Division of Pediatric Cardiology, University of New Mexico, Albuquerque (J.C.L.)., Berdjis F; Children's Hospital of Orange County, CA (F.B.)., Gillespie MJ; The Children's Hospital of Philadelphia, PA (J.J.R., M.J.G.)., McElhinney DB; Departments of Pediatrics and Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center, Stanford University School of Medicine, Palo Alto, CA (D.B.M.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2018 Aug; Vol. 11 (8), pp. e006453.
DOI:	10.1161/CIRCINTERVENTIONS.118.006453
Abstrakt:	Background: Percutaneous transcatheter pulmonary valve replacement (TPVR) has good clinical and hemodynamic outcomes in treating dysfunctional bioprosthetic valves (BPV) in the pulmonary position. Valve-in-valve therapy can further decrease the inner diameter (ID), potentially resulting in patient-prosthesis mismatch in patients with smaller BPVs. Methods and Results: To evaluate feasibility and outcomes of intentional BPV fracture to enlarge the pulmonary valve orifice with TPVR, 37 patients from 13 centers who underwent TPVR with intended BPV fracture were evaluated. A control cohort (n=70) who underwent valve-in-valve TPVR without attempted fracture was evaluated. BPV was successfully fractured in 28 patients and stretched in 5 while fracture was unsuccessful in 4. A Melody valve was implanted in 25 patients with fractured/stretched frame and a Sapien (XT 3) valve in 8. Among patients whose BPV was fractured/stretched, the final ID was a median of 2 mm larger (0-6.5 mm) than the valve's true ID. The narrowest diameter after TPVR in controls was a median of 2 mm smaller ( P<0.001) than true ID. Right ventricular outflow tract gradient decreased from median 40 to 8 mm Hg in the fracture group. Cases with fracture/stretching were matched 1:1 (weight, true ID) to controls. Post-TPVR peak gradient was lower but not significant (8.3±5.2 versus 11.8±9.2 mm Hg; P=0.070). There were no fracture-related adverse events. Conclusions: Preliminary experience shows intentional fracture of BPV frame can be useful for achieving larger ID and better hemodynamics after valve-in-valve TPVR.
Databáze:	MEDLINE
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