Right ventricular outflow tract obstruction associated with neointimal tissue accumulation and distortion of the Harmony TPV25 stent frame: Potential mechanisms and treatment.

Autor: Steinberg ZL; Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA., Cabalka AK; Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA.; Division of Structural Heart Diseases, Mayo Clinic, Rochester, Minnesota, USA., Balzer DT; Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA., Asnes JD; Department of Pediatric Cardiology, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA., Morray BH; Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington, USA., Gillespie MJ; Division of Pediatric Cardiology, University of Pennsylvania School of Medicine and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., McElhinney DB; Departments of Cardiothoracic Surgery and Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA.
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2023 Nov; Vol. 102 (6), pp. 1078-1087. Date of Electronic Publication: 2023 Nov 05.
DOI: 10.1002/ccd.30901
Abstrakt: Background: The Harmony TPV25 transcatheter pulmonary valve (Medtronic Inc.) is constructed with a self-expanding stent frame comprising six zigged nitinol wires sewn together and covered with knitted polyester fabric, with flared inflow and outflow ends and a porcine pericardial valve sutured to the central portion of the device. It was approved for treatment of pulmonary regurgitation after prior right ventricular outflow tract repair in 2021. Early outcomes of this procedure have been excellent, but little is known about valve durability or ultimate mechanisms of dysfunction.
Methods: We collected data on patients who underwent reintervention for TPV25 dysfunction and described findings related to distortion of the stent frame and tissue accumulation.
Results: We describe six patients who underwent valve-in-valve implant for TPV25 obstruction (peak catheterization gradient peak 28-73 mmHg) 10-28 months after implant. In all cases, there was tissue accumulation within the inflow and valve-housing segments of the device and deformation of the self-expanding valve frame characterized by variable circumferential narrowing at the junction between the valve housing and the inflow and outflow portions of the device, with additional geometric changes in all segments. All six patients underwent valve-in-valve implant that results in a final peak gradient ≤10 mmHg and no regurgitation.
Discussion: The occurrence of short-term Harmony TPV25 dysfunction in multiple patients with a similar appearance of frame distortion and tissue accumulation within the inflow and valve housing portions of the device suggests that this may be an important failure mechanism for this valve. Potential causes of the observed findings are discussed. It is possible to treat this mechanism of TPV25 dysfunction with valve-in-valve implant using balloon expandable transcatheter valves.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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