Outcomes After Transcatheter Reintervention for Dysfunction of a Previously Implanted Transcatheter Pulmonary Valve
| Autor: | Evan M. Zahn, Lars Søndergaard, Felix Berger, John P. Cheatham, Andreas Eicken, Julie A. Vincent, Jonathan J. Rome, Jacqueline Kreutzer, Shabana Shahanavaz, Shicheng Weng, Lisa Bergersen, Thomas K. Jones, Doff B. McElhinney, David T. Balzer |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Balloon Valvuloplasty Male Cardiac Catheterization medicine.medical_specialty Time Factors Adolescent medicine.medical_treatment 030204 cardiovascular system & hematology Ventricular Outflow Obstruction Young Adult 03 medical and health sciences 0302 clinical medicine Pulmonary Valve Replacement medicine Humans Ventricular outflow tract balloon dilation In patient 030212 general & internal medicine Child Heart Valve Prosthesis Implantation Pulmonary Valve business.industry pulmonary valvuloplasty Stent Recovery of Function Middle Aged Pulmonary Valve Insufficiency Prosthesis Failure Surgery Treatment Outcome medicine.anatomical_structure Quartile Heart Valve Prosthesis Pulmonary valve pulmonary valve replacement Cohort Balloon dilation Female Melody valve Cardiology and Cardiovascular Medicine business |
| Zdroj: | Shahanavaz, S, Berger, F, Jones, T K, Kreutzer, J, Vincent, J A, Eicken, A, Bergersen, L, Rome, J J, Zahn, E, Søndergaard, L, Cheatham, J P, Weng, S, Balzer, D & McElhinney, D 2020, ' Outcomes After Transcatheter Reintervention for Dysfunction of a Previously Implanted Transcatheter Pulmonary Valve ', JACC: Cardiovascular Interventions, vol. 13, no. 13, pp. 1529-1540 . https://doi.org/10.1016/j.jcin.2020.03.035 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2020.03.035 |
| Popis: | Objectives The aim of this analysis was to evaluate outcomes following transcatheter reintervention for degenerated transcatheter pulmonary valves (TPVs). Background TPV replacement (TPVR) with the Melody valve demonstrated sustained relief of right ventricular outflow tract (RVOT) obstruction and pulmonary regurgitation. Methods All patients who underwent TPVR with a Melody valve as part of 3 Medtronic-sponsored prospective multicenter studies were included. Transcatheter reinterventions included balloon dilation of the previously implanted Melody valve, placement of a bare-metal stent within the implanted TPV, or placement of a new TPV in the RVOT (TPV-in-TPV). Indications for reintervention, decisions to reintervene, and the method of reintervention were at physician discretion. All patients provided written informed consent to participate in the trials, and each trial was approved by local or central Institutional Review Boards or ethics committees at participating sites. Results A total of 309 patients who underwent TPVR were discharged from the implantation hospitalization with Melody valves in place. Transcatheter reintervention on the TPV was performed in 46 patients. The first transcatheter reintervention consisted of TPV-in-TPV in 28 patients (median 6.9 years [quartile 1 to quartile 3: 5.2 to 7.8 years] after TPVR), simple balloon dilation of the implanted Melody valve in 17 (median 4.9 years [quartile 1 to quartile 3: 4.0 to 6.0 years] after TPVR), and bare-metal stent placement alone in 1 (4.4 years after TPVR). There were no major procedural complications. Overall, 4-year freedom from explant and from any later RVOT reintervention after the first reintervention were 83% and 60%, respectively. Freedom from repeat RVOT reintervention was longer in patients undergoing TPV-in-TPV than balloon dilation (71% vs. 46% at 4 years; p = 0.027). Conclusions TPV-in-TPV can be an effective and durable treatment for Melody valve dysfunction. Although balloon dilation of the Melody valve was also acutely effective at reducing RVOT obstruction, the durability of this therapy was limited in this cohort compared with TPV-in-TPV. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|