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

2 Citations (Scopus)

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

Fingerprint

Pulmonary Valve
Congenital Heart Defects
Ventricular Pressure
Heart Diseases
Arterial Pressure
Pathologic Constriction
Magnetic Resonance Spectroscopy
Exercise
Blood Pressure
Therapeutics

Cite this

Percutaneous management of failed bioprosthetic pulmonary valves in patients with congenital heart defects. / Tarzia, Pierpaolo; Conforti, Erika; Giamberti, Alessandro; Varrica, Alessandro; Giugno, Luca; Micheletti, Angelo; Negura, Diana; Piazza, Luciane; Saracino, Antonio; Carminati, Mario; Chessa, Massimo.

In: Journal of Cardiovascular Medicine, Vol. 18, No. 6, 06.2017, p. 430-435.

Research output: Contribution to journalArticle

Tarzia, Pierpaolo ; Conforti, Erika ; Giamberti, Alessandro ; Varrica, Alessandro ; Giugno, Luca ; Micheletti, Angelo ; Negura, Diana ; Piazza, Luciane ; Saracino, Antonio ; Carminati, Mario ; Chessa, Massimo. / Percutaneous management of failed bioprosthetic pulmonary valves in patients with congenital heart defects. In: Journal of Cardiovascular Medicine. 2017 ; Vol. 18, No. 6. pp. 430-435.
@article{5271149bb3e94bf58735c75205a9a6d8,
title = "Percutaneous management of failed bioprosthetic pulmonary valves in patients with congenital heart defects",
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.",
author = "Pierpaolo Tarzia and Erika Conforti and Alessandro Giamberti and Alessandro Varrica and Luca Giugno and Angelo Micheletti and Diana Negura and Luciane Piazza and Antonio Saracino and Mario Carminati and Massimo Chessa",
year = "2017",
month = "6",
doi = "10.2459/JCM.0000000000000486",
language = "English",
volume = "18",
pages = "430--435",
journal = "Journal of Cardiovascular Medicine",
issn = "1558-2027",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Percutaneous management of failed bioprosthetic pulmonary valves in patients with congenital heart defects

AU - Tarzia, Pierpaolo

AU - Conforti, Erika

AU - Giamberti, Alessandro

AU - Varrica, Alessandro

AU - Giugno, Luca

AU - Micheletti, Angelo

AU - Negura, Diana

AU - Piazza, Luciane

AU - Saracino, Antonio

AU - Carminati, Mario

AU - Chessa, Massimo

PY - 2017/6

Y1 - 2017/6

N2 - 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.

AB - 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.

U2 - 10.2459/JCM.0000000000000486

DO - 10.2459/JCM.0000000000000486

M3 - Article

C2 - 27828833

VL - 18

SP - 430

EP - 435

JO - Journal of Cardiovascular Medicine

JF - Journal of Cardiovascular Medicine

SN - 1558-2027

IS - 6

ER -