Pulmonary Valve Replacement Function in Adolescents: A Comparison of Bioprosthetic Valves and Homograft Conduits

Batlivala, Sarosh P.; Emani, Sitaram M.; Mayer, John E.; McElhinney, Doff B.

doi:10.1016/j.athoracsur.2012.02.039

Cited by 95 publications

(73 citation statements)

References 33 publications

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“…[12][13][14][15][16] As we have learned more about the effects of chronic volume and pressure overload on the RV, 15,16 the optimal point at which to intervene for RV outflow tract dysfunction remains a moving target. However, there seems to be a trend toward earlier intervention at many centers, [17][18][19] and there is some evidence that earlier RV outflow tract intervention may provide a tangible benefit. 20 A likely contributing factor affecting this trend is the ability to restore conduit function with less invasive modalities, namely TPV placement.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Short-Term Outcomes of Percutaneous Transcatheter Pulmonary Valve Replacement in Small (<30 kg) Children With Dysfunctional Right Ventricular Outflow Tract Conduits

Berman

McElhinney

Vincent

et al. 2014

Circ: Cardiovascular Interventions

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Patients weighing <30 kg were excluded from the initial clinical trial and, as such, limited data exist regarding the feasibility, safety, and efficacy of this procedure in small children with dysfunctional right ventricle-pulmonary artery (RV-PA) conduits. Methods Study DesignThis study was performed as a multicenter retrospective review designed to capture all patients <30 kg who underwent cardiac catheterization with intention to place a TPV at the initial 3 sites involved in the US Investigational Device Exemption (IDE) Melody valve trial (Boston Children's Hospital, Miami Children's Hospital, and Children's Hospital of New York) through May 2011. Techniques for Melody valve implant in these smaller patients were generally similar to what has been reported previously. Any modifications, including vascular access site, were at the discretion of the operator and are reported in the Results section.Data collected included demographic, preprocedural, procedural, and follow-up data. Patients were classified into 1 of 3 groups based on preprocedural findings: primary conduit stenosis, primary conduit regurgitation, mixed conduit stenosis, and regurgitation. Data were reviewed and analyzed to assess the feasibility of Melody valve implantation, as well as the acute and follow-up hemodynamic results of Melody valve implantation in this cohort of patients.Institutional review board approval for this retrospective review was obtained from each institution involved. Two patients did not undergo TPV implant (risk of coronary compression in 1; inability to advance the delivery sheath beyond the common femoral vein in 1). After successful TPV implant, the peak conduit gradient fell from 29±16 to 9±6 mm Hg (P<0.001), and all but 2 patients had no/trivial regurgitation (down from moderate or severe preimplant in 20). TPV implant was via the femoral vein in 17 patients, the right internal jugular vein in 4, and the left subclavian vein in 2 patients. At a median follow-up of 16 months, 1 patient underwent conduit replacement for recurrent conduit stenosis, 2 developed stent fracture requiring a second TPV, and 2 developed bacterial endocarditis treated with antibiotics, 1 of whom then underwent conduit replacement. The average Melody valve mean Doppler gradient and conduit regurgitation were unchanged from early postimplant. Conclusions-Percutaneous TPV replacement can be performed in small children with good procedural and early hemodynamic results in the majority of patients. (Circ Cardiovasc Interv. 2014;7:142-148.) Background-In

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Section: Discussionmentioning

confidence: 99%

Feasibility and Short-Term Outcomes of Percutaneous Transcatheter Pulmonary Valve Replacement in Small (<30 kg) Children With Dysfunctional Right Ventricular Outflow Tract Conduits

Berman

McElhinney

Vincent

et al. 2014

Circ: Cardiovascular Interventions

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“…15,16 Pericardial valves are often implanted in the pulmonary position in children and young adults with tetralogy of Fallot, some of whom have high pulmonary artery pressure, with reasonable durability. 17,18 Moreover, enthusiasm for bioprosthetic AVR has increased with the prospect of valve-in-valve technology, 19,20 which could reduce the number of anticipated surgical valve rereplacements. However, the acuity of calcification and resultant critical stenosis of the Mitroflow LXA valve in our series of children and very young adults greatly outweigh the potential benefits or rationale for its implantation.…”

Section: Discussionmentioning

confidence: 99%

Accelerated Degeneration of a Bovine Pericardial Bioprosthetic Aortic Valve in Children and Young Adults

et al. 2014

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Background-Experience with aortic valve replacement (AVR) with current-generation pericardial bioprostheses in young patients is limited. The death of a child with accelerated bioprosthetic aortic stenosis prompted enhanced surveillance of all such patients at our institution. Methods and Results-We reviewed records of 27 patients who had undergone AVR (median follow-up, 13.7 months) with a bovine pericardial bioprosthesis at ≤30 years of age. In the Mitroflow LXA valve group (n=15), freedom from valve failure was 100% at 1 year, 53% (95% confidence interval, 12-82) at 2 years, and 18% (95% confidence interval,

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“…[36,42] Our choice for a biological valve was in agreement with the vast majority of the reported studies, where tissue valves currently form the mainstay of the surgical treatment for patients with PV regurgitation. [3,34–41,43–48] Despite the numerous biological valves available for implantation in PV position, the optimal valve choice remains unknown, partly because long-term outcomes are deficient owing to structural valve deterioration necessitating further treatment. [43]…”

Section: Discussionmentioning

confidence: 99%

“…While general agreement exists on the need for a PV implantation in the presence of severe PV regurgitation after surgical treatment for congenital heart defects, extensive debates accompany the following issues: timing of PV implantation, particularly in asymptomatic patients;[6–8,10,14–25]choice of the approach, between percutaneous interventional [6,26–33] versus surgical [8,10,12–19,34–38] PV implantation;choice of the most suitable valve;[3,34–48] androle of the surgical right ventricular remodelling. [49–51]…”

Section: Introductionmentioning

confidence: 99%

Trifecta St. Jude medical® aortic valve in pulmonary position

Corno

Dawson

Bolger

et al. 2017

Nano Reviews & Experiments

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Introduction: To evaluate an aortic pericardial valve for pulmonary valve (PV) regurgitation after repair of congenital heart defects. Methods: From July 2012 to June 2016 71 patients, mean age 24 ± 13 years (four to years) underwent PV implantation of aortic pericardial valve, mean interval after previous repair = 21 ± 10 years (two to 47 years). Previous surgery at mean age 3.2 ± 7.2 years (one day to 49 years): tetralogy of Fallot repair in 83% (59/71), pulmonary valvotomy in 11% (8/71), relief of right ventricular outflow tract (RVOT) obstruction in 6% (4/71). Pre-operative echocardiography and MRI showed severe PV regurgitation in 97% (69/71), moderate in 3% (2/71) with associated RVOT obstruction. MRI and knowledge-based reconstruction 3D volumetry (KBR-3D-volumetry) showed mean PV regurgitation = 42 ± 9% (20–58%), mean indexed RV end-diastolic volume = 169 ± 33 (130–265) ml m–2 BSA and mean ejection fraction (EF) = 46 ± 8% (33–61%). Cardio-pulmonary exercise showed mean peak O2/uptake = 24 ± 8 ml kg–1 min–1 (14–45 ml kg–1 min–1), predicted max O2/uptake 66 ± 17% (26–97%). Pre-operative NYHA class was I in 17% (12/71) patients, II in 70% (50/71) and III in 13% (9/71). Results: Mean cardio-pulmonary bypass duration was 95 ± 30ʹ (38–190ʹ), mean aortic cross-clamp in 23% (16/71) 46 ± 31ʹ (8–95ʹ), with 77% (55/71) implantations without aortic cross-clamp. Size of implanted PV: 21 mm in seven patients, 23 mm in 33, 25 mm in 23, and 27 mm in eight. The z-score of the implanted PV was −0.16 ± 0.80 (−1.6 to 2.5), effective orifice area indexed (for BSA) of native PV was 1.5 ± 0.2 (1.2 to –2.1) vs. implanted PV 1.2 ± 0.3 (0.76 to –2.5) (p = ns). In 76% (54/71) patients surgical RV modelling was associated. Mean duration of mechanical ventilation was 6 ± 5 h (0–26 h), mean ICU stay 21 ± 11 h (12–64 h), mean hospital stay 6 ± 3 days (three to 19 days). In mean follow-up = 25 ± 14 months (six to 53 months) there were no early/late deaths, no need for cardiac intervention/re-operation, no valve-related complications, thrombosis or endocarditis. Last echocardiography showed absent PV regurgitation in 87.3% (62/71) patients, trivial/mild degree in 11.3% (8/71), moderate degree in 1.45% (1/71), mean max peak velocity through RVOT 1.6 ± 0.4 (1.0–2.4) m s–1. Mean indexed RV end-diastolic volume at MRI/KBR-3D-volumetry was 96 ± 20 (63–151) ml m–2 BSA, lower than pre-operatively (p < 0.001), and mean EF = 55 ± 4% (49–61%), higher than pre-operatively (p < 0.05). Almost all patients (99% = 70/71) remain in NYHA class I, 1.45% = 1/71 in class II. Conclusion: (a) Aortic pericardial valve is implantable in PV position with an easy and reproducible surgical technique; (b) valve size adequate for patient BSA can be implanted with simultaneous RV remodelling; (c) medium-term outcomes are good with maintained PV function, RV dimensions significantly reduced and EF significantly improved; (d) adequate valve size will allow later percutaneous valve-in-valve implantation.

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Pulmonary Valve Replacement Function in Adolescents: A Comparison of Bioprosthetic Valves and Homograft Conduits

Cited by 95 publications

References 33 publications

Feasibility and Short-Term Outcomes of Percutaneous Transcatheter Pulmonary Valve Replacement in Small (<30 kg) Children With Dysfunctional Right Ventricular Outflow Tract Conduits

Feasibility and Short-Term Outcomes of Percutaneous Transcatheter Pulmonary Valve Replacement in Small (<30 kg) Children With Dysfunctional Right Ventricular Outflow Tract Conduits

Accelerated Degeneration of a Bovine Pericardial Bioprosthetic Aortic Valve in Children and Young Adults

Trifecta St. Jude medical® aortic valve in pulmonary position

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