Coronary artery bypass graft surgery remains one of the most widely performed surgical procedures in North America and aortocoronary saphenous vein grafts (SVG) are the most frequently used surgical conduits. SVG disease (SVGD) remains the leading cause of symptomatic coronary artery disease postcoronary artery bypass graft. When optimal medical therapy is ineffective, repeat surgery is associated with higher mortality combined with less favorable clinical and angiographic results, thus percutaneous revascularization on SVG is currently the standard of care for the revascularization of SVGD. Balloon angioplasty, bare metal stents, polytetrafluoroethylene-covered stents, and drug-eluting stents have been extensively investigated for SVG interventions. Multiple recent randomized trials and meta-analyses have confirmed the pathophysiologic and clinical differences between SVGD and coronary artery disease. Decisions such as patient selection, premedication, stent, and protection device characteristics should be carefully considered to achieve optimal procedural and clinical results. Acute coronary syndromes due to SVG involvement, chronic total occlusions, retrograde approaches, and SVG perforation management are newer fields requesting additional research.
Percutaneous pulmonary valve implantation (PPVI) using the Melody TM valve has proved to be safe and effective with excellent outcomes at experienced centers for treatment of dysfunctional right ventricular to pulmonary artery conduits (RV-PA) as well as bioprosthetic valves [1,2]. Predilation with a high-pressure balloon of the RV-PA conduit is an important step for optimizing the hemodynamic outcome of the Melody valve implantation and relief of right ventricular outflow tract (RVOT) obstruction.In this edition of CCI, Joseph Mahgerefteh et al. elegantly present an interesting novel technique for the percutaneous management of an iatrogenic tear of the conduit by placement of a bare metal stent in the initially implanted Melody valve and implantation of a second Melody valve more distally. Conduit tear or rupture during PPVI has been previously described [1] and is a potential and serious complication, requiring either emergency surgery or use of a covered stent that currently is not approved in the US. As optimal gradient relief is important, expansion of shrunken conduits up to nominal size before PPVI may result in conduit fracture, tear, and significant bleeding in about 1-5% of the cases [3]. Incidence of extravasation is much higher when expanding the conduit well beyond its nominal size. It is also important to keep in mind that the valved stent will not cover both ends of the conduit. Although it is clearly off-label use, sealing of the conduit tear by the vein graft of a second Melody valve more distally was successful in this case.During these very exciting times of rapidly evolving percutaneous technologies and techniques for complex structural heart diseases, authors have clearly shown the creative mind set that we all need to have, given the limited on-label indications for approved devices.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.