Percutaneous management of failed bioprosthetic pulmonary valves in patients with congenital heart defects.
OBJECTIVE
We reviewed our center experience in the field of transcatheter pulmonary valve-in-valve implantation (TPViV), that is emerging as a treatment option for patients with pulmonary bioprosthetic valve (BPV) dysfunction.


METHODS
Between April 2008 and September 2015, a total of six patients with congenital heart disease (four men) underwent TPViV due to stenosis of preexisting BPV. Four patients received a Melody Medtronic Transcatheter Pulmonary Valve and two an Edward Sapien Valve.


RESULTS
No procedural-related complications occurred. After valve implantation, right ventricular systolic pressure (RVSP, 80.5 ± 25.3-41.2 ± 8.35 mmHg, P < 0.05), right ventricular outflow tract (RVOT) gradient (55.3 ± 23.4-10.6 ± 3.8 mmHg, P < 0.05), and RVSP-to-aortic pressure (0.75 ± 0.21-0.38 ± 0.21, P = 0.01) fell significantly. Echocardiograms at follow-up revealed a significant reduction in estimated RVSP (88.7 ± 22-21.7 ± 4.7 mmHg, P < 0.05), in RVOT (76.2 ± 17.9-25.7 ± 6.1 mmHg, P = 0.005), and in mean RVOT (40.7 ± 9.9-15.5 ± 4.8 mmHg, P < 0.05) gradients. Cardiac magnetic resonance showed no significant change in biventricular dimensions and function. Symptomatic patients reported improvement of symptoms, although cardiopulmonary exercise did not show any significant differences.


CONCLUSIONS
TPViV is an effective and well tolerated treatment for BPV dysfunction, improving freedom from surgical reintervention. Long-term studies will redefine the management of dysfunctional RVOT, either native or surrogate.
aPediatric and Adult Congenital Heart Centre, IRCCS, Policlinico San Donato, University Hospital, Via Morandi, 30, San Donato M.se, Milan 20097, Italy bInstitute of Cardiology, Catholic University of the Sacred Heart, IRCCS Policlinico Universitario 'Agostino Gemelli', Rome, Italy.
Pierpaolo
P
Tarzia
Erika
E
Conforti
Alessandro
A
Giamberti
Alessandro
A
Varrica
Luca
L
Giugno
Angelo
A
Micheletti
Diana
D
Negura
Luciane
L
Piazza
Antonio
A
Saracino
Mario
M
Carminati
Massimo
M
Chessa
D000293:Adolescent; D000328:Adult; 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*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D011664:Pulmonary Valve / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult