Percutaneous pulmonary Melody® valve implantation in small conduits

Bensemlali, Myriam; Malekzadeh‐Milani, Sophie; Mostefa-Kara, Meriem; Bonnet, Damien; Boudjemline, Younès

doi:10.1016/j.acvd.2016.12.013

Cited by 14 publications

(9 citation statements)

References 24 publications

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“…A small conduit diameter (<16mm) seems to be associated with early valve failure [ 46 ], although the acute hemodynamic results of the Melody implantation were good in these patients.…”

Section: Methodsmentioning

confidence: 99%

Percutaneous Pulmonary Valve Implantation: Current Status and Future Perspectives

Driesen

Warmerdam

Sieswerda

et al. 2019

CCR

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Patients with congenital heart disease (CHD) with right ventricle outflow tract (RVOT) dysfunction need sequential pulmonary valve replacements throughout their life in the majority of cases. Since their introduction in 2000, the number of percutaneous pulmonary valve implantations (PPVI) has grown and reached over 10,000 procedures worldwide. Overall, PPVI has been proven safe and effective, but some anatomical variations can limit procedural success. This review discusses the current status and future perspectives of the procedure.

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“…A small conduit diameter (<16mm) seems to be associated with early valve failure [ 46 ], although the acute hemodynamic results of the Melody implantation were good in these patients.…”

Section: Methodsmentioning

confidence: 99%

Percutaneous Pulmonary Valve Implantation: Current Status and Future Perspectives

Driesen

Warmerdam

Sieswerda

et al. 2019

CCR

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“…[10][11][12][13] Short-and medium-term results of TPVR in adolescents and adults are excellent, with recent publications indicating a trend toward earlier TPVR and extended application in younger children and smaller conduits. [14][15][16][17] While these studies report encouraging early results, the limits and longterm safety of TPVR have yet to be fully defined. In particular, in the setting of isolated RVOT obstruction, it is important to identify competing risk-benefit profiles for the aforementioned strategies.…”

Section: Introductionmentioning

confidence: 99%

“…In the current era, transcatheter pulmonary valve replacement (TPVR), which allows for treatment of both stenosis and regurgitation, has been increasingly integrated into the management algorithm of a dysfunctional RVOT 10–13 . Short‐ and medium‐term results of TPVR in adolescents and adults are excellent, with recent publications indicating a trend toward earlier TPVR and extended application in younger children and smaller conduits 14–17 . While these studies report encouraging early results, the limits and long‐term safety of TPVR have yet to be fully defined.…”

Section: Introductionmentioning

confidence: 99%

Is there a role for endovascular stent implantation in the management of postoperative right ventricular outflow tract obstruction in the era of transcatheter valve implantation?

Kang

Ramroop²,

Manojlovich

et al. 2021

Cathet Cardio Intervent

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Background The optimal management pathway for the dysfunctional right ventricular outflow tract (RVOT) is uncertain. We evaluated the long‐term outcomes and clinical impact of stent implantation for obstructed RVOTs in an era of rapidly progressing transcatheter pulmonary valve technology. Methods Retrospective review of 151 children with a biventricular repair who underwent stenting of obstructed RVOT between 1991 and 2017. Results RVOT stenting resulted in significant changes in peak right ventricle (RV)‐to‐pulmonary artery (PA) gradient (39.4 ± 17.1–14.9 ± 8.3; p < 0.001) and RV‐to‐aortic pressure ratio (0.78 ± 0.22–0.49 ± 0.13; p < 0.001). Subsequent percutaneous reinterventions in 51 children to palliate recurrent stenosis were similarly effective. Ninety‐nine (66%) children reached the primary outcome of subsequent pulmonary valve replacement (PVR). Freedom from PVR from the time of stent implantation was 91%, 51%, and 23% at 1, 5, and 10 years, respectively. Small balloon diameters for stent deployment were associated with shorter freedom from PVR. When additional children without stent palliation (with RV‐to‐PA conduits) were added to the stent cohort (total 506 children), the multistate analysis showed the longest freedom from PVR in those with stent palliation and subsequent catheter reintervention. Pulmonary regurgitation was well‐tolerated clinically. Indexed RV dimensions and function estimated by echocardiography remained stable at last follow up or before primary outcome. Conclusion Prolongation of conduit longevity with stent implant remains an important strategy to allow for somatic growth to optimize the risk‐benefit profile for subsequent surgical or transcatheter pulmonary valve replacement performed at an older age.

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“…A small conduit diameter (< 16mm) seems to be associated with early valve failure 46 , although the acute haemodynamic results of the Melody implantation were good in these patients.…”

Section: Clinical Outcomesmentioning

confidence: 88%

“…Ejection fraction of the systemic ventricle, typically a good indicator of cardiac function, can be normal in patients with Fontan circulation, despite clinical signs of circulatory failure. 46 There are several reasons why ejection fraction is not representative of ventricular function in this patient group: the abnormal position and geometry of the systemic ventricle, the atrioventricular valve regurgitation that many patients with a Fontan circulation have, and the fact that it is a load sensitive marker. The first exploratory studies suggest that kinetic energy assessment has the potential to provide novel information on ventricular dysfunction in the Fontan circulation and can lead to new insights into the physiology of this complex circulation.…”

Section: Fontan Circulationmentioning

confidence: 94%

Advanced imaging and intervention in congenital heart disease

Warmerdam¹

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Background. Even after successful repair for coarctation of the aorta (CoA) abnormal blood flow patterns can be expected due to aortic narrowing, a changed aortic geometry after repair, or generalized aortopathy, all of which may have a negative impact on left ventricular (LV) performance. The aim of this study is to investigate the relationship between aortic haemodynamics assessed by four-dimensional flow (4D flow) cardiac magnetic resonance imaging (CMR) and LV performance in CoA patients. Methods.CoA patients with a clinical indication for CMR underwent additional 4D flow acquisition. Wall shear stress, oscillatory shear index, vorticity, viscous dissipation, energy loss, kinetic energy and velocity angle were assessed for several aortic segments at peak-systole. Global pulse wave velocity (PWV) was assessed for the entire aorta, as well as LV ejection fraction, volumes, and mass.Results. A total of 17 CoA patients were included. Increased velocity angle in the ascending aorta was correlated with decreased LV mass (p = 0.0445). Energy loss at the CoA site and increased degree of vorticity in the descending aorta were correlated with increased LV end-diastolic and end-systolic volume (p = 0.0499, p = 0.0461, respectively). PWV was correlated with LV mass and LV end-systolic volume (p = 0.0385, p = 0.0397, respectively). Apart from energy loss the CoA site, all correlations remained significant after correction for age. Conclusion.Adverse aortic-ventricular interaction in CoA patients was demonstrated by abnormal aortic haemodynamics by 4D flow assessment and was associated with impaired LV performance. 4D flow CMR may provide novel parameters to assess aorticventricular interaction in patients with CoA.

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Percutaneous pulmonary Melody® valve implantation in small conduits

Cited by 14 publications

References 24 publications

Percutaneous Pulmonary Valve Implantation: Current Status and Future Perspectives

Percutaneous Pulmonary Valve Implantation: Current Status and Future Perspectives

Is there a role for endovascular stent implantation in the management of postoperative right ventricular outflow tract obstruction in the era of transcatheter valve implantation?

Advanced imaging and intervention in congenital heart disease

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