Which is the best tissue valve used in the pulmonary position, late after previous repair of tetralogy of Fallot?: Table 1:

Abbas, Jonathan R.; Hoschtitzky, J. Andreas

doi:10.1093/icvts/ivt332

Cited by 38 publications

(12 citation statements)

References 15 publications

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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%

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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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Section: Discussionmentioning

confidence: 99%

“…[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%

Trifecta St. Jude medical® aortic valve in pulmonary position

Corno

Dawson

Bolger

et al. 2017

Nano Reviews & Experiments

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“…The search for the perfect prosthesis for the pulmonary valve is almost as old as congenital cardiac surgery itself [7][8][9][10]. A few centres prefer mechanical prostheses in this context and have had acceptable results.…”

Section: Discussionmentioning

confidence: 99%

No-React® Injectable BioPulmonic™ Valves Re-evaluated: Discouraging Follow-up Results

Siepe¹,

Höhn²,

Fleck³

et al. 2016

Thorac cardiovasc Surg

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OBJECTIVES: The No-React® Injectable BioPulmonic™ valve (BioIntegral) was introduced for minimally invasive off-pump replacement of the pulmonary valve almost 10 years ago. We present our mid-to long-term follow-up results. METHODS: We conducted a retrospective analysis of all 7 patients treated at our institution at the median age of 9 (range 1-24) years. The children underwent cardiac catheterization when worsening strain on the right heart was suspected after examining their medical history and/or observing significant changes on echocardiography. RESULTS: After a median follow-up period lasting 5.2 (range 0.7-6.7) years, all patients presented the indication for recatheterization, particularly because the maximum instantaneous velocity measured by Doppler had revealed systolic gradients of a median 63 (dP 18-74) mmHg across the right ventricular outflow. Catheterization confirmed severe stenosis in 2, and moderate stenosis together with moderate insufficiency in 4 patients. We observed two principal failure mechanisms: technical problems resulting from poor alignment to the right ventricular outflow tract and structural problems leading to neointimal proliferation even in cases with appropriate prosthesis positioning. At median of 5.7 (0.7-7) years after implantation, 6 of the 7 patients underwent valve rereplacement. Redo surgery was necessary in 3, and percutaneous valve-in-valve implantation in the remaining 3 patients. Histological analysis of two explanted valves confirmed significant neointima proliferation and thickened valve cusps leading to stenosis of the graft. CONCLUSIONS: These mid-term results after implantation of the No-React® Injectable BioPulmonic™ valve are disappointing. Graft failure was mainly due to neointimal formation and valve malposition.

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“…Regarding the choice of the most suitable valve to implant in PV position, the first choice is not for a mechanical prosthesis, despite the proven longevity, because of the risks of thromboembolic phenomena and the requirement for life-long anticoagulation ( 41 , 48 ), with tissue valves considered as the first choice for PV implantation ( 2 , 39 – 49 ). Despite the various models of biological valves available for implantation in PV position, the optimal valve choice remains unknown, partly because long-term out-comes are deficient owing to structural valve deterioration necessitating further treatment ( 48 ).…”

Section: Choice Of the Most Suitable Valve For Surgical Implantationmentioning

confidence: 99%

Pulmonary Valve Regurgitation: Neither Interventional Nor Surgery Fits All

Corno

2018

Front. Pediatr.

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Introduction: PV implantation is indicated for severe PV regurgitation after surgery for congenital heart defects, but debates accompany the following issues: timing of PV implantation; choice of the approach, percutaneous interventional vs. surgical PV implantation, and choice of the most suitable valve.Timing of pulmonary valve implantation: The presence of symptoms is class I evidence indication for PV implantation. In asymptomatic patients indication is agreed for any of the following criteria: PV regurgitation > 20%, indexed end-diastolic right ventricular volume > 120–150 ml/m2 BSA, and indexed end-systolic right ventricular volume > 80–90 ml/m2 BSA.Choice of the approach: percutaneous interventional vs. surgical: The choice of the approach depends upon the morphology and the size of the right ventricular outflow tract, the morphology and the size of the pulmonary arteries, the presence of residual intra-cardiac defects and the presence of extremely dilated right ventricle.Choice of the most suitable valve for surgical implantation: Biological valves are first choice in most of the reported studies. A relatively large size of the biological prosthesis presents the advantage of avoiding a right ventricular outflow tract obstruction, and also of allowing for future percutaneous valve-in-valve implantation. Alternatively, biological valved conduits can be implanted between the right ventricle and pulmonary artery, particularly when a reconstruction of the main pulmonary artery and/or its branches is required.Hybrid options: combination of interventional and surgical: Many progresses extended the implantation of a PV with combined hybrid interventional and surgical approaches. Major efforts have been made to overcome the current limits of percutaneous PV implantation, namely the excessive size of a dilated right ventricular outflow tract and the absence of a cylindrical geometry of the right ventricular outflow tract as a suitable landing for a percutaneous PV implantation.Conclusion: Despite tremendous progress obtained with modern technologies, and the endless fantasy of researchers trying to explore new forms of treatment, it is too early to say that either the interventional or the surgical approach to implant a PV can fit all patients with good long-term results.

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Which is the best tissue valve used in the pulmonary position, late after previous repair of tetralogy of Fallot?: Table 1:

Cited by 38 publications

References 15 publications

Trifecta St. Jude medical® aortic valve in pulmonary position

Trifecta St. Jude medical® aortic valve in pulmonary position

No-React® Injectable BioPulmonic™ Valves Re-evaluated: Discouraging Follow-up Results

Pulmonary Valve Regurgitation: Neither Interventional Nor Surgery Fits All

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