title: Immediate and long-term outcomes of percutaneous transcatheter pulmonary valve implantation.
abstract: Transcutaneous pulmonary valve replacement (TPVR) has become an alternative to heart surgery for patients after previous right ventricular outflow tract (RVOT) or pulmonary artery (PA) surgical interventions. The objective was to present immediate and long-term outcomes of trans¬cutaneous pulmonary valve replacement.
  
  
  
  Between 06/2009 and 06/2016, 46 patients underwent TPVR. Initial diagnoses included tetralogy of Fallot, common arterial trunk, transposition of great arteries post Rastelli correction, left ventricle outflow obstruction after Ross operation, pulmonary atresia, and isolated dysplastic pulmonary valve stenosis. Thirty eight (78%) patients had previously implanted conduits in the pulmonary position, the rest had either RVOT patch reconstruction (n = 6; 13%) or biological valve implantation (n = 2; 4%). They presented primarily with pulmonary stenosis (n = 18; 39%) or regurgitation (n = 28; 60%).
  
  
  
  All procedures were successful - 44 Melody and 2 Edwards-Sapien valves were implanted. Before each procedure exclusion of potential coronary compression and RVOT prestenting was performed. Significant RVOT systolic gradient reduction (from 35.3 ± 19.5 to 13.5 ± 7.1 mm Hg; p < 0.001) and decrease of right to left ventricle systolic pressure ratio from 0.58 ± 0.18 to mean 0.37 ± 0.1 (p < 0.001) was achieved. Also, in every patient PA-RVOT competence was restored, with minor in¬competence in only a few patients. Post procedure follow-up ranged from 2 to 86 (mean 35.2) months. Follow-up fluoroscopy or chest X-ray revealed 6 stent fractures (2 stent defragmentation - with only 1 significant valve stenosis).
  
  
  
  Transcutaneous pulmonary valve replacement is a safe procedure with encouraging results, it also enables deferring surgical reintervention in the majority of patients.
authors.affiliation: Silesian Center for Heart Diseases Department of Congenital Heart Diseases and Pediatric Cardiology. rfiszer@gumed.edu.pl.
authors.forename: Roland
authors.initials: R
authors.lastname: Fiszer
authors.forename: Paweł
authors.initials: P
authors.lastname: Dryżek
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Szkutnik
authors.forename: Sebastian
authors.initials: S
authors.lastname: Góreczny
authors.forename: Alexandra
authors.initials: A
authors.lastname: Krawczuk
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Moll
authors.forename: Tomasz
authors.initials: T
authors.lastname: Moszura
authors.forename: Szymon
authors.initials: S
authors.lastname: Pawlak
authors.forename: Jacek
authors.initials: J
authors.lastname: Białkowski
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: congenital heart disease; pulmonary valve; transcatheter valve implantation