title: Percutaneous pulmonary valve implantation for free pulmonary regurgitation following conduit-free surgery of the right ventricular outflow tract.
abstract: BACKGROUND
  Pulmonary regurgitation (PR) following surgery of the right ventricular outflow tract (RVOT) is not innocent and leads to significant right heart dysfunction over time. Recent studies have demonstrated that percutaneous valves can be implanted in conduit free outflow tracts with good outcomes.
  
  
  OBJECTIVE
  To evaluate in patients with severe PR--anticipated to require future pulmonary valve replacement--the feasibility and safety of pre-stenting dilated non-stenotic patched conduit-free right ventricular outflow tracts before excessive dilation occurs, followed by percutaneous pulmonary valve implantation (PPVI).
  
  
  METHODS
  Twenty seven patients were evaluated, but only 23 were deemed suitable based on the presence of an adequate retention zone ≤ 24 mm defined by semi-compliant balloon interrogation of the RVOT. A 2 step procedure was performed: first the landing zone was prepared by deploying a bare stent, followed 2 months later by valve implantation.
  
  
  RESULTS
  RVOT pre-stenting with an open cell bare metal stent (Andrastent XXL range) was performed at a median age of 13.0 years (range: 6.0-44.9) with a median weight of 44.3 kg (range: 20.0-88.0). Ninety six percent (22/23) of patients proceeded to PPVI a median of 2.4 months (range: 1.4-3.4) after initial pre-stent placement. Twenty one Melody valves and one 26 mm Edwards SAPIEN™ valve were implanted. Complications consisted of embolization of prestent (n = 1), scrunching (n = 4) and mild stent dislocation (n = 2). During follow-up, no stent fractures were observed and right ventricular dimensions decreased significantly.
  
  
  CONCLUSIONS
  Post-surgical conduit-free non-stenotic RVOT with free pulmonary regurgitation can be treated percutaneously with a valved stent if anatomical (predominantly size) criteria are met. In experienced hands, the technique is feasible with low morbidity.
authors.affiliation: Paediatric Cardiology, University Hospitals Leuven, Belgium.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Cools
authors.affiliation: Paediatric Cardiology, University Hospitals Leuven, Belgium; University of the Free State, South Africa.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Brown
authors.affiliation: Paediatric Cardiology, University Hospitals Leuven, Belgium.
authors.forename: Ruth
authors.initials: R
authors.lastname: Heying
authors.affiliation: Paediatric Cardiology, University Hospitals Leuven, Belgium.
authors.forename: Katrijn
authors.initials: K
authors.lastname: Jansen
authors.affiliation: Paediatric Cardiology, University Hospitals Leuven, Belgium.
authors.forename: Derize E
authors.initials: DE
authors.lastname: Boshoff
authors.affiliation: Paediatric Cardiology, University Hospitals Leuven, Belgium.
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
authors.affiliation: Paediatric Cardiology, University Hospitals Leuven, Belgium. Electronic address: marc.gewillig@uzleuven.be.
authors.forename: Marc
authors.initials: M
authors.lastname: Gewillig
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D002648:Child; D017023:Coronary Angiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000502:physiology; D011665:Pulmonary Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D015607:Stents; D016278:Ventricular Function, Right; D055815:Young Adult
keywords: Balloon; Intervention; Percutaneous pulmonary valve; Stent