title: Percutaneous pulmonary valve implantation: two-centre experience with more than 100 patients.
abstract: OBJECTIVE
  Dysfunction of valved conduits in the right ventricular outflow tract (RVOT) limits durability and enforces repeated surgical interventions. We report on our combined two-centre experience with percutaneous pulmonary valve implantation (PPVI).
  
  
  RESULTS
  One hundred and two patients with RVOT dysfunction [median weight: 63 kg (54.2-75.9 kg), median age: 21.5 years (16.2-30.1 years), diagnoses: TOF/PA 61, TAC 14, TGA 9, other 10, AoS post-Ross-OP 8] were scheduled for PPVI since December 2006. Percutaneous pulmonary valve implantation was performed in all patients. Pre-stenting of the RVOT was done in 97 patients (95%). The median peak systolic RVOT gradient decreased from 37 mmHg (29-46 mmHg) to 14 mmHg (9-17 mmHg, P < 0.001) and the ratio RV pressure/AoP decreased from 62% (53-76%) to 36% (30-42%, P < 0.0001). The median end-diastolic RV-volume index (MRI) decreased from 106 mL/m(2) (93-133 mL/m(2)) to 90 mL/m(2) (71-108 mL/m(2), P = 0.001). Pulmonary regurgitation was significantly reduced in all patients. One patient died due to compression of the left coronary artery. The incidence of stent fractures was 5 of 102 (5%). During follow-up [median: 352 days (99-390 days)] one percutaneous valve had to be removed surgically 6 months after implantation due to bacterial endocarditis. In 8 of 102 patients, a repeated dilatation of the valve was done due to a significant residual systolic pressure gradient, which resulted in a valve-in-valve procedure in four.
  
  
  CONCLUSIONS
  This study shows that PPVI is feasible and it improves the haemodynamics in a selected patient collective. Apart from one coronary compression, the rate of complications at short-term follow-up was low. Percutaneous pulmonary valve implantation can be performed by experienced interventionalists with similar results as originally published. The intervention is technically challenging and longer clinical follow-up is needed.
authors.affiliation: Klinik für Kinderkardiologie und angeboren Herzfehler, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, München, Germany. eicken@dhm.mhn.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Eicken
authors.forename: Peter
authors.initials: P
authors.lastname: Ewert
authors.forename: Alfred
authors.initials: A
authors.lastname: Hager
authors.forename: Bjoern
authors.initials: B
authors.lastname: Peters
authors.forename: Sohrab
authors.initials: S
authors.lastname: Fratz
authors.forename: Titus
authors.initials: T
authors.lastname: Kuehne
authors.forename: Raymonde
authors.initials: R
authors.lastname: Busch
authors.forename: John
authors.initials: J
authors.lastname: Hess
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
mesh_terms: D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D011664:Pulmonary Valve; D011665:Pulmonary Valve Insufficiency / Q000601:surgery*; D019233:Retreatment; D016896:Treatment Outcome; D055815:Young Adult