title: Percutaneous pulmonary valve-in-valve implantation: a successful treatment concept for early device failure.
abstract: OBJECTIVE
  Percutaneous pulmonary valve implantation (PPVI) is now an accepted treatment strategy for right ventricular (RV) outflow tract (RVOT) dysfunction in many European Heart Centres. We analysed the efficacy of repeat PPVI as a treatment modality for early device failure.
  
  
  RESULTS
  Twenty patients underwent repeat PPVI for RVOT obstruction because of early device failure ('Hammock effect', 'Hammock-like effect', stent fracture, residual stenosis). Repeat PPVI was feasible in all patients with no procedural complications. Following implantation of a second device, catheter-measured RVOT gradient and RV systolic pressure fell significantly (RVOT gradient: 46.1 +/- 3.9 to 18.1 +/- 2.4 mmHg, P < 0.001; RVSP: 70.9 +/- 4.8 to 46.1 +/- 2.6 mmHg, P < 0.001), in all but one patient (15 years, male, common arterial trunk, 11.5 mm homograft). During follow-up, four of 20 required re-intervention [third PPVI for stent fracture (n = 2), device explantation: external compression by the sternum (n = 1), endocarditis (n = 1)], and one of the 20 is awaiting surgical management. In the remainder, second PPVI resulted in a sustained improvement in haemodynamics with a mean follow-up of 10.9 +/- 3.0 months. In this series, the probability of freedom from re-intervention at 2 years was higher after second PPVI when compared with the index procedure (89.4 vs. 20.0%, P < 0.001).
  
  
  CONCLUSIONS
  Repeat PPVI is an effective treatment for early device failure in defined conditions and leads to improved freedom from re-intervention.
authors.affiliation: Cardiothoracic Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
authors.forename: Johannes
authors.initials: J
authors.lastname: Nordmeyer
authors.forename: Louise
authors.initials: L
authors.lastname: Coats
authors.forename: Philipp
authors.initials: P
authors.lastname: Lurz
authors.forename: Twin-Yen
authors.initials: TY
authors.lastname: Lee
authors.forename: Graham
authors.initials: G
authors.lastname: Derrick
authors.forename: Philipp
authors.initials: P
authors.lastname: Rees
authors.forename: Seamus
authors.initials: S
authors.lastname: Cullen
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Taylor
authors.forename: Sachin
authors.initials: S
authors.lastname: Khambadkone
authors.forename: Philipp
authors.initials: P
authors.lastname: Bonhoeffer
mesh_terms: D000293:Adolescent; D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D011664:Pulmonary Valve; D011665:Pulmonary Valve Insufficiency / Q000628:therapy*; D055502:Secondary Prevention; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000628:therapy*