title: Factors associated with the internal jugular venous approach for Melody™ Transcatheter Pulmonary Valve implantation.
abstract: BACKGROUND
  Transcatheter pulmonary valve implantation is usually performed from a femoral venous - transfemoral - approach, but this may not be the optimal vascular access option in some patients. This study aimed to determine which group of patients might benefit from an internal jugular - transjugular - approach for transcatheter pulmonary valve implantation.
  
  
  METHODS
  This multicentre retrospective study included all patients who underwent attempted transcatheter pulmonary valve placement in the right ventricular outflow tract between April 2010 and June 2012 at two large congenital heart centres. Patients were divided into two groups based on venous access site - transfemoral or transjugular. Patient characteristics, procedural outcomes, and complications were compared between groups.
  
  
  RESULTS
  Of 81 patients meeting the inclusion criteria (median age 16.4 years), the transjugular approach was used in 14 patients (17%). The transjugular group was younger (median age 11.9 versus 17.3 years), had lower body surface area (mean 1.33 versus 1.61 m2), more often had moderate or greater tricuspid regurgitation (29% versus 7%), and had a higher ratio of right ventricle-to-systemic systolic pressure (mean 82.4 versus 64.7). Patients requiring a transjugular approach after an unsuccessful transfemoral approach had longer fluoroscopic times and procedure duration.
  
  
  CONCLUSIONS
  The transjugular approach for transcatheter pulmonary valve implantation is used infrequently but is more often used in younger and smaller patients. Technical limitations from a transfemoral approach may be anticipated if there is moderate or greater tricuspid regurgitation or higher right ventricular pressures. In these patients, a transjugular approach should be considered early.
authors.affiliation: 1Department of Pediatric Cardiology,University of Michigan,Ann Arbor,Michigan,United States of America.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Zampi
authors.affiliation: 2Department of Pediatric Cardiology,Nationwide Children's Hospital,Columbus,Ohio,United States of America.
authors.forename: Darren P
authors.initials: DP
authors.lastname: Berman
authors.affiliation: 1Department of Pediatric Cardiology,University of Michigan,Ann Arbor,Michigan,United States of America.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Bocks
authors.affiliation: 1Department of Pediatric Cardiology,University of Michigan,Ann Arbor,Michigan,United States of America.
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.affiliation: 3Department of Pediatric Cardiology,Cedars-Sinai Hospital,Los Angeles,California,United States of America.
authors.forename: Evan M
authors.initials: EM
authors.lastname: Zahn
authors.affiliation: 1Department of Pediatric Cardiology,University of Michigan,Ann Arbor,Michigan,United States of America.
authors.forename: Jimmy C
authors.initials: JC
authors.lastname: Lu
authors.affiliation: 4University of Michigan Medical School,Ann Arbor,Michigan,United States of America.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Shaya
authors.affiliation: 1Department of Pediatric Cardiology,University of Michigan,Ann Arbor,Michigan,United States of America.
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Armstrong
mesh_terms: D000293:Adolescent; D002648:Child; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007601:Jugular Veins / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011664:Pulmonary Valve / Q000002:abnormalities* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology; D055815:Young Adult
keywords: Transcatheter pulmonary valve; congenital heart disease; interventional paediatric cardiology