Percutaneous management of failed bioprosthetic pulmonary valves in patients with congenital heart defects

Pierpaolo Tarzia, Erika Conforti, Alessandro Giamberti, Alessandro Varrica, Luca Giugno, Angelo Micheletti, Diana Negura, Luciane Piazza, Antonio Saracino, Mario Carminati, Massimo Chessa

Research output: Contribution to journalArticle

Abstract

AIMS: We reviewed our center experience in the field of transcatheter pulmonary valve-in-valve implantation (TPViV), that is emerging as a treatment option for patients with pulmonary bioprosthetic valve (BPV) dysfunction.

METHODS: Between April 2008 and September 2015, a total of six patients with congenital heart disease (four men) underwent TPViV due to stenosis of preexisting BPV. Four patients received a Melody Medtronic Transcatheter Pulmonary Valve and two an Edward Sapien Valve.

RESULTS: No procedural-related complications occurred. After valve implantation, right ventricular systolic pressure (RVSP, 80.5 ± 25.3-41.2 ± 8.35 mmHg, P < 0.05), right ventricular outflow tract (RVOT) gradient (55.3 ± 23.4-10.6 ± 3.8 mmHg, P < 0.05), and RVSP-to-aortic pressure (0.75 ± 0.21-0.38 ± 0.21, P = 0.01) fell significantly. Echocardiograms at follow-up revealed a significant reduction in estimated RVSP (88.7 ± 22-21.7 ± 4.7 mmHg, P < 0.05), in RVOT (76.2 ± 17.9-25.7 ± 6.1 mmHg, P = 0.005), and in mean RVOT (40.7 ± 9.9-15.5 ± 4.8 mmHg, P < 0.05) gradients. Cardiac magnetic resonance showed no significant change in biventricular dimensions and function. Symptomatic patients reported improvement of symptoms, although cardiopulmonary exercise did not show any significant differences.

CONCLUSION: TPViV is an effective and well tolerated treatment for BPV dysfunction, improving freedom from surgical reintervention. Long-term studies will redefine the management of dysfunctional RVOT, either native or surrogate.

Original languageEnglish
Pages (from-to)430-435
Number of pages6
JournalJournal of Cardiovascular Medicine
Volume18
Issue number6
DOIs
Publication statusPublished - Jun 2017

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