Transcatheter Pulmonary Valve Replacement With the Melody Valve in Small Diameter Expandable Right Ventricular Outflow Tract Conduits

Autor: Jamil Aboulhosn, Britton C. Keeshan, Younes Boudjemline, Daniel S. Levi, Hoang H. Nguyen, Doff B. McElhinney, Lynn F. Peng, Robert G. Gray, Athar M. Qureshi, Thomas K. Jones, Henri Justino, David T. Balzer, Jeremy D. Asnes, Mary Hunt Martin, Holly Bauser-Heaton, Shabana Shahanavaz
Rok vydání: 2017
Předmět:
Adult
Male
medicine.medical_specialty
Cardiac Catheterization
Small diameter
Time Factors
Adolescent
medicine.medical_treatment
030204 cardiovascular system & hematology
Prosthesis Design
Ventricular Outflow Obstruction
03 medical and health sciences
Blood Vessel Prosthesis Implantation
Young Adult
0302 clinical medicine
Pulmonary Valve Replacement
Internal medicine
medicine.artery
medicine
Ventricular outflow tract
Humans
030212 general & internal medicine
Child
Tetralogy of Fallot
Retrospective Studies
Heart Valve Prosthesis Implantation
Pulmonary Valve
business.industry
Angiography
Graft Occlusion
Vascular
Hemodynamics
Stent
medicine.disease
United States
Blood Vessel Prosthesis
Treatment Outcome
Child
Preschool
Heart Valve Prosthesis
Pulmonary artery
Cardiology
Feasibility Studies
Female
Cardiology and Cardiovascular Medicine
business
Preliminary Data
Zdroj: JACC. Cardiovascular interventions. 11(6)
ISSN: 1876-7605
Popis: This study sought to evaluate the safety, feasibility, and outcomes of transcatheter pulmonary valve replacement (TPVR) in conduits ≤16 mm in diameter.The Melody valve (Medtronic, Minneapolis, Minnesota) is approved for the treatment of dysfunctional right ventricular outflow tract (RVOT) conduits ≥16 mm in diameter at the time of implant. Limited data are available regarding the use of this device in smaller conduits.The study retrospectively evaluated patients from 9 centers who underwent percutaneous TPVR into a conduit that was ≤16 mm in diameter at the time of implant, and reported procedural characteristics and outcomes.A total of 140 patients were included and 117 patients (78%; median age and weight 11 years of age and 35 kg, respectively) underwent successful TPVR. The median original conduit diameter was 15 (range: 9 to 16) mm, and the median narrowest conduit diameter was 11 (range: 4 to 23) mm. Conduits were enlarged to a median diameter of 19 mm (29% larger than the implanted diameter), with no difference between conduits. There was significant hemodynamic improvement post-implant, with a residual peak RVOT pressure gradient of 7 mm Hg (p 0.001) and no significant pulmonary regurgitation. During a median follow-up of 2.0 years, freedom from RVOT reintervention was 97% and 89% at 2 and 4 years, respectively, and there were no deaths and 5 cases of endocarditis (incidence rate 2.0% per patient-year).In this preliminary experience, TPVR with the Melody valve into expandable small diameter conduits was feasible and safe, with favorable early and long-term procedural and hemodynamic outcomes.
Databáze: OpenAIRE
Externí odkaz: