Acute and Midterm Outcomes of Transcatheter Pulmonary Valve Replacement for Treatment of Dysfunctional Left Ventricular Outflow Tract Conduits in Patients With Aortopulmonary Transposition and a Systemic Right Ventricle. Circ Cardiovasc Interv 2017 Sep;10(9)
Date
08/31/2017Pubmed ID
28851718DOI
10.1161/CIRCINTERVENTIONS.116.004730Scopus ID
2-s2.0-85030973268 (requires institutional sign-in at Scopus site) 6 CitationsAbstract
BACKGROUND: Transcatheter pulmonary valve replacement (TPVR) is an established therapy for dysfunctional right ventricular (RV) outflow tract conduits. TPVR in patients with congenitally corrected transposition of the great arteries, subpulmonary left ventricle, and left ventricular outflow tract (LVOT) conduit dysfunction has not been studied. Unique anatomic and physiological aspects of this population may contribute to distinct risks and outcomes.
METHODS AND RESULTS: Across 10 US centers, 27 patients with a dysfunctional LVOT conduit were evaluated in the catheterization laboratory between December 2008 and August 2015 with the intent to perform TPVR. TPVR was successful in 23 patients (85%). Five serious adverse events occurred in 4 cases (15%), including pulmonary hemorrhage, hypotension requiring vasoactive support, conduit disruption requiring covered stent (n=2), and acute RV dysfunction with flash pulmonary edema. After TPVR, the LVOT peak systolic ejection gradient decreased from median of 35 to 17 mm Hg (P<0.001); pulmonary insufficiency was trivial/none in all but 1 patient, where it was mild. Worsening of systemic RV dysfunction or tricuspid regurgitation was seen in 12 patients (57%) and was associated with a significantly lower post-TPVR LVOT peak systolic ejection gradient (median 17 versus 21 mm Hg; P=0.02) and higher post-TPVR RV sphericity index (median 0.88 versus 0.52; P=0.004). Post-TPVR, there were 2 late deaths because of RV failure and 1 cardiac transplantation because of progressive RV dysfunction and tricuspid regurgitation.
CONCLUSIONS: TPVR in dysfunctional LVOT conduits is feasible but associated with an important rate of TPV nonimplantation and procedural serious adverse events. Worsening systemic RV function and tricuspid regurgitation may develop after LVOT TPVR.
Author List
Whiteside W, Tretter JT, Aboulhosn J, Aldoss O, Armstrong AK, Bocks ML, Gillespie MJ, Jones TK, Martin MH, Meadows JJ, Metcalf CM, Turner ME, Zellers T, Goldstein BHAuthor
Christina Metcalf Mckinney MD Adjunct Instructor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Bioprosthesis
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
Cardiac Catheterization
Child
Feasibility Studies
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Heart Ventricles
Humans
Male
Middle Aged
Postoperative Complications
Prosthesis Design
Pulmonary Valve
Pulmonary Valve Insufficiency
Recovery of Function
Retrospective Studies
Risk Factors
Time Factors
Transposition of Great Vessels
Treatment Outcome
United States
Ventricular Function, Left
Ventricular Function, Right
Young Adult
