Implantation of the Medtronic Harmony Transcatheter Pulmonary Valve Improves Right Ventricular Size and Function in an Ovine Model of Postoperative Chronic Pulmonary Insufficiency
| Autor: | Gerald A Zsido, Matthew J. Gillespie, Satoshi Takebayashi, Matthew A. Harris, Toru Shimaoka, Wobbe Bouma, Joseph H. Gorman, Timothy S. Kim, Harold Litt, Robert C. Gorman, Yoav Dori, Rosanne C. Schoonbeek, Jeremy R. McGarvey, Gregory L. Fu, Jonathan J. Rome, Chikashi Aoki, Andrew C. Glatz |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
pulmonary valve regurgitation Pulmonary insufficiency 030204 cardiovascular system & hematology REGURGITATION Article 03 medical and health sciences 0302 clinical medicine Pulmonary Valve Replacement Internal medicine medicine magnetic resonance imaging 030212 general & internal medicine Heart valve tetralogy of Fallot Tetralogy of Fallot REPAIR cardiac catheterization Ejection fraction business.industry HEART-VALVE computed tomography ADULTS FALLOT medicine.disease Surgery heart valve prosthesis implantation REPLACEMENT OUTFLOW TRACT CLINICAL-EXPERIENCE medicine.anatomical_structure Pulmonary valve Ventricular fibrillation Regurgitant fraction Cardiology TETRALOGY TRIAL Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation-Cardiovascular interventions, 9(10):003920. LIPPINCOTT WILLIAMS & WILKINS |
| ISSN: | 1941-7640 |
| Popis: | Background— Pulmonary insufficiency is the nexus of late morbidity and mortality after transannular patch repair of tetralogy of Fallot. This study aimed to establish the feasibility of implantation of the novel Medtronic Harmony transcatheter pulmonary valve (hTPV) and to assess its effect on pulmonary insufficiency and ventricular function in an ovine model of chronic postoperative pulmonary insufficiency. Methods and Results— Thirteen sheep underwent baseline cardiac magnetic resonance imaging, surgical pulmonary valvectomy, and transannular patch repair. One month after transannular patch repair, the hTPV was implanted, followed by serial magnetic resonance imaging and computed tomography imaging at 1, 5, and 8 month(s). hTPV implantation was successful in 11 animals (85%). There were 2 procedural deaths related to ventricular fibrillation. Seven animals survived the entire follow-up protocol, 5 with functioning hTPV devices. Two animals had occlusion of hTPV with aneurysm of main pulmonary artery. A strong decline in pulmonary regurgitant fraction was observed after hTPV implantation (40.5% versus 8.3%; P =0.011). Right ventricular end diastolic volume increased by 49.4% after transannular patch repair (62.3–93.1 mL/m 2 ; P =0.028) but was reversed to baseline values after hTPV implantation (to 65.1 mL/m 2 at 8 months, P =0.045). Both right ventricular ejection fraction and left ventricular ejection fraction were preserved after hTPV implantation. Conclusions— hTPV implantation is feasible, significantly reduces pulmonary regurgitant fraction, facilitates right ventricular volume improvements, and preserves biventricular function in an ovine model of chronic pulmonary insufficiency. This percutaneous strategy could potentially offer an alternative for standard surgical pulmonary valve replacement in dilated right ventricular outflow tracts, permitting lower risk, nonsurgical pulmonary valve replacement in previously prohibitive anatomies. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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