title: Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome.
abstract: BACKGROUND
  Percutaneous pulmonary valve implantation was introduced in the year 2000 as a nonsurgical treatment for patients with right ventricular outflow tract dysfunction.
  
  
  RESULTS
  Between September 2000 and February 2007, 155 patients with stenosis and/or regurgitation underwent percutaneous pulmonary valve implantation. This led to significant reduction in right ventricular systolic pressure (from 63+/-18 to 45+/-13 mm Hg, P<0.001) and right ventricular outflow tract gradient (from 37+/-20 to 17+/-10 mm Hg, P<0.001). Follow-up ranged from 0 to 83.7 months (median 28.4 months). Freedom from reoperation was 93% (+/-2%), 86% (+/-3%), 84% (+/-4%), and 70% (+/-13%) at 10, 30, 50, and 70 months, respectively. Freedom from transcatheter reintervention was 95% (+/-2%), 87% (+/-3%), 73% (+/-6%), and 73% (+/-6%) at 10, 30, 50, and 70 months, respectively. Survival at 83 months was 96.9%. On time-dependent analysis, the first series of 50 patients (log-rank test P<0.001) and patients with a residual gradient >25 mm Hg (log-rank test P=0.01) were associated with a higher risk of reoperations.
  
  
  CONCLUSIONS
  Percutaneous pulmonary valve implantation resulted in the ability to avoid surgical right ventricular outflow tract revision in the majority of cases. This procedure might reduce the number of operations needed over the total lifetime of patients with right ventricle-to-pulmonary artery conduits.
authors.affiliation: UCL Institute of Child Health, London, United Kingdom.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lurz
authors.forename: Louise
authors.initials: L
authors.lastname: Coats
authors.forename: Sachin
authors.initials: S
authors.lastname: Khambadkone
authors.forename: Johannes
authors.initials: J
authors.lastname: Nordmeyer
authors.forename: Younes
authors.initials: Y
authors.lastname: Boudjemline
authors.forename: Silvia
authors.initials: S
authors.lastname: Schievano
authors.forename: Vivek
authors.initials: V
authors.lastname: Muthurangu
authors.forename: Twin Yen
authors.initials: TY
authors.lastname: Lee
authors.forename: Giovanni
authors.initials: G
authors.lastname: Parenzan
authors.forename: Graham
authors.initials: G
authors.lastname: Derrick
authors.forename: Seamus
authors.initials: S
authors.lastname: Cullen
authors.forename: Fiona
authors.initials: F
authors.lastname: Walker
authors.forename: Victor
authors.initials: V
authors.lastname: Tsang
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Taylor
authors.forename: Philipp
authors.initials: P
authors.lastname: Bonhoeffer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data / Q000639:trends; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D011664:Pulmonary Valve / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome; D014463:Ultrasonography; D014694:Ventricular Outflow Obstruction / Q000209:etiology / Q000601:surgery*