Percutaneous pulmonary valve implantation.
Percutaneous pulmonary valve implantation is a new treatment option in patients with dysfunctional conduits. The aim of percutaneous pulmonary valve implantation is to prolong the lifespan of right ventricle to pulmonary artery conduits and thereby postponing open-heart surgery. Early results have shown a significant reduction in right ventricular pressure and right ventricular outflow tract gradient. During a follow-up of a median of 28 months, freedom from re-operation is 93 (2), 86 (3), 84 (4), and 70 (13)% at 10, 30, 50, and 70 months, respectively. The most common complication during follow-up are stent fractures with an incidence around 20%. Although clinically silent in the majority of cases, stent fractures led to re-intervention in the form of implantation of a second device (valve-in-valve). Valvar function during follow-up was well maintained. Significant pulmonary regurgitation was only seen in the context of endocarditis. Pulmonary valve implantation has the potential to become the standard procedure in the treatment of dysfunctional conduits. Bigger challenges will now have to be met in order to extend this technology to patients with native outflow tracts and free pulmonary regurgitation.
UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
Philipp
P
Lurz
Regis
R
Gaudin
Andrew M
AM
Taylor
Philipp
P
Bonhoeffer
D006328:Cardiac Catheterization; D002404:Catheterization / Q000379:methods; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D011664:Pulmonary Valve / Q000002:abnormalities* / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000601:surgery*; D015607:Stents; D014694:Ventricular Outflow Obstruction / Q000601:surgery