title: Transcatheter valve implantation for right atrium-to-right ventricle conduit obstruction or regurgitation after modified Björk-fontan procedure.
abstract: BACKGROUND
  The most common reason for reintervention after a Björk modification of the Fontan procedure, in which the right ventricle (RV) is incorporated into the pulmonary circulation by connecting the right atrial (RA) appendage to the RV directly or with an extra-anatomic graft, is obstruction or regurgitation of the RA-RV connection. Transcatheter implantation of a valved stent is an appealing option for the treatment of RA-RV conduit dysfunction in these patients. In the present study, we assessed early and intermediate results after transcatheter valve implantation within an obstructed or regurgitant RA-RV modified Fontan pathway.
  
  
  METHODS
  Through a retrospective multicenter registry, we collected data from 16 patients with a modified Fontan circulation who were treated with percutaneous Melody or Sapien valve implantation for dysfunction of an extra-anatomic RA-RV conduit or valve.
  
  
  RESULTS
  All patients had successful and uncomplicated implantation of a Melody (n = 15) or Sapien 3 (n = 1) valve with hemodynamic and, in most cases, clinical improvement. During a median follow-up of 3.3 years, 3 patients died of cardiovascular causes unrelated to the procedure or the valve, and no major valve dysfunction was observed.
  
  
  CONCLUSIONS
  Percutaneous transcatheter valve deployment to treat a dysfunctional RA-RV connection after a Björk modification of the Fontan procedure is a viable alternative to surgery, with low procedural risk, and appears to offer good early and intermediate results.© 2016 Wiley Periodicals, Inc.
authors.affiliation: Toronto General Hospital, Toronto, Canada.
authors.forename: Ashish H
authors.initials: AH
authors.lastname: Shah
authors.affiliation: Toronto General Hospital, Toronto, Canada.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horlick
authors.affiliation: German Heart Centre, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Eicken
authors.affiliation: Yale University, New Haven, Connecticut.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Asnes
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Bocks
authors.affiliation: Necker Enfants Malades Hospital, Paris, France.
authors.forename: Younes
authors.initials: Y
authors.lastname: Boudjemline
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Allison K
authors.initials: AK
authors.lastname: Cabalka
authors.affiliation: University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Fagan
authors.affiliation: Deutsches Herzzentrum, Berlin, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Schubert
authors.affiliation: University of California, San Francisco, California.
authors.forename: Vaikom S
authors.initials: VS
authors.lastname: Mahadevan
authors.affiliation: St. Paul's Hospital, Vancouver, Canada.
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.affiliation: Toronto General Hospital, Toronto, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Osten
authors.affiliation: Stanford University, Palo Alto, California.
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
mesh_terms: D000328:Adult; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D002170:Canada; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005060:Europe; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects* / Q000379:methods; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D011474:Prosthesis Design; D011475:Prosthesis Failure; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: Fontan conversio; percutaneous valve replacement; total cavopulmonary connection; tricuspid valve replacement