Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome.
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.
Lurz
Philipp
P
UCL Institute of Child Health, London, United Kingdom.
Coats
Louise
L
Khambadkone
Sachin
S
Nordmeyer
Johannes
J
Boudjemline
Younes
Y
Schievano
Silvia
S
Muthurangu
Vivek
V
Lee
Twin Yen
TY
Parenzan
Giovanni
G
Derrick
Graham
G
Cullen
Seamus
S
Walker
Fiona
F
Tsang
Victor
V
Deanfield
John
J
Taylor
Andrew M
AM
Bonhoeffer
Philipp
P
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*