title: Predictors and outcomes of right ventricular outflow tract conduit rupture during percutaneous pulmonary valve implantation: a multicentre study.
abstract: OBJECTIVE
  Conduit rupture is a serious complication encountered during percutaneous pulmonary valve implantation (PPVI). We sought to evaluate the incidence and predictors of conduit rupture during right ventricular outflow tract (RVOT) transcatheter treatment.
  
  
  RESULTS
  All consecutive patients who underwent transcatheter RVOT treatment from May 2008 to December 2011 were prospectively studied. Baseline demographics along with incidence, predictors and outcomes of conduit rupture with various transcatheter therapies were reviewed. Conduit rupture occurred in nine out of 99 patients (9.09%). All conduit ruptures occurred during balloon dilatation. Significant risk factors included heavy calcification (p<0.05, OR=16 [1.87-357]), and conduit type (homograft/others; p<0.05, OR=4.37 [1.1-17.8]). Other factors such as prolonged time interval between prior surgical RVOT repair and interventions, use of high-pressure balloons, balloon diameter, and overexpansion of conduit statistically failed to show any association. All patients were managed in the cardiac catheterisation laboratory. There were no delayed complications during a mean follow-up period of 2.3±0.95 years.
  
  
  CONCLUSIONS
  Conduit rupture is a serious complication. Heavy calcification and homograft conduit were significant predictors. Immediate diagnosis with the use of targeted interventional therapies should be attempted before proceeding with PPVI.
authors.affiliation: Department of Paediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: Younes
authors.initials: Y
authors.lastname: Boudjemline
authors.forename: Sophie
authors.initials: S
authors.lastname: Malekzadeh-Milani
authors.forename: Mehul
authors.initials: M
authors.lastname: Patel
authors.forename: Jean-Benoit
authors.initials: JB
authors.lastname: Thambo
authors.forename: Damien
authors.initials: D
authors.lastname: Bonnet
authors.forename: Laurence
authors.initials: L
authors.lastname: Iserin
authors.forename: Alain
authors.initials: A
authors.lastname: Fraisse
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D063126:Balloon Valvuloplasty / Q000009:adverse effects; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D016009:Chi-Square Distribution; D002932:Cineangiography; D005260:Female; D005602:France; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D011475:Prosthesis Failure; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D055815:Young Adult