Transcatheter Valve Replacement for Right-sided Valve Disease in Congenital Heart Patients

The Role of Novel Transcatheter Procedures in Patients With Congenital Heart Disease

“…41 Most pediatric surgeons recommend bioprosthetic valves in the tricuspid and pulmonary positions and mechanical valves in the mitral position and either a mechanical valve or, less commonly, an autograft valve in the aortic position (Ross procedure). 12,41,54,55 Nevertheless, some patients have a contraindication to anticoagulation or a predilection for thrombus formation or prefer to avoid anticoagulation and also may receive bioprosthetic valves on the left side. Recently, some families are even requesting bioprosthetic AoV so that their child subsequently can receive a valve-invalve (ViV) TAVR rather than a reoperative valve replacement.…”

“…Results using the Harmony valve (Medtronic, Minneapolis, MN) in the United States are encouraging, although a limited number of valve sizes are available, thus excluding a large number of patients. 8,55 In addition, the Alterra Adaptive Pre-Stent (Edwards Lifesciences, Irvine, CA) is in clinical trials and was designed to remodel the native RVOT internally so that a Sapien S3 subsequently can be implanted in the neo-RVOT. 55 Ultimately, the hope is that transcatheter PVR technology will offer a significantly lower risk option than reoperative surgery for patients requiring PVR regardless of their original anatomy.…”

“…In addition, THVs that can be placed into a native non-calcified annulus (ViN) are undergoing trials in the United States. 55,[88][89][90] Mitral THV rarely will be an option for most CHD patients, because rings rarely are used in young patients since they inhibit growth of the annulus; and the predominant use of mechanical valves in this population will not enable ViV placement. Conversely, tricuspid THV procedures, especially ViV, is much more likely to be an alternative to surgical reoperations given the common use of bioprosthetic valves in the tricuspid position.…”

“…Conversely, tricuspid THV procedures, especially ViV, is much more likely to be an alternative to surgical reoperations given the common use of bioprosthetic valves in the tricuspid position. 5,52,55 Transcatheter Mitral Heart Valve Replacement…”

“…Early results of procedural success with the Gate Tricuspid Valved Stent (Navigate Cardiac Structure Inc) have been reported in adult patients with secondary TR. 55 Since the annulus size and position are usually normal in patients with primary leaflet pathology, this therapy may become relevant for patients with milder forms of the disease depending on the degree of leaflet and subvalvular abnormalities. This elongated LVOT occurs to some extent in all types of AVC (partial, transitional, and complete canals).…”