Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement.

OBJECTIVES To determine the safety and feasibility of over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement. BACKGROUND Transcatheter pulmonary valve placement is an alternative to surgical pulmonary valve replacement. Traditionally, it was thought to be unsafe to expand a conduit to >110% of its original size. METHODS This retrospective cohort study from two centers includes patients with right ventricle to pulmonary artery conduits with attempted transcatheter pulmonary valve placement from 2010 to 2017. Demographic, procedural, echocardiographic and follow-up data, and complications were evaluated in control and overdilation (to >110% original conduit size) groups. RESULTS One hundred and seventy-two patients (51 overdilation and 121 control) had attempted transcatheter pulmonary valve placement (98% successful). The overdilation group was younger (11.2 versus 16.7 years, p < 0.001) with smaller conduits (15 versus 22 mm, p < 0.001); however, the final valve size was not significantly different (19.7 versus 20.2 mm, p = 0.2). Baseline peak echocardiographic gradient was no different (51.8 versus 55.6 mmHg, p = 0.3). Procedural complications were more frequent in overdilation (18%) than control (7%) groups (most successfully addressed during the procedure). One patient from each group required urgent surgical intervention, with no procedural mortality. Follow-up echocardiographic peak gradients were similar (24.1 versus 26 mmHg, p = 0.5). CONCLUSIONS Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement can be performed successfully. Procedural complications are more frequent with conduit overdilation, but there was no difference in the rate of life-threatening complications. There was no difference in valve function at most recent follow-up, and no difference in rate of reintervention. The long-term outcomes of transcatheter pulmonary valve placement with conduit over-expansion requires further study.

[1]  J. Cheatham,et al.  Reintervention and Survival After Transcatheter Pulmonary Valve Replacement , 2022, Journal of the American College of Cardiology.

[2]  J. Rome,et al.  Outcomes After Transcatheter Reintervention for Dysfunction of a Previously Implanted Transcatheter Pulmonary Valve. , 2020, JACC. Cardiovascular interventions.

[3]  C. Dauphin,et al.  French national survey on infective endocarditis and the Melody™ valve in percutaneous pulmonary valve implantation. , 2018, Archives of cardiovascular diseases.

[4]  D. McElhinney,et al.  Transcatheter Pulmonary Valve Replacement With the Melody Valve in Small Diameter Expandable Right Ventricular Outflow Tract Conduits. , 2018, JACC. Cardiovascular interventions.

[5]  D. McElhinney,et al.  Percutaneous transcatheter pulmonary valve replacement in children weighing less than 20 kg , 2018, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[6]  J. Cheatham,et al.  Relationships Among Conduit Type, Pre-Stenting, and Outcomes in Patients Undergoing Transcatheter Pulmonary Valve Replacement in the Prospective North American and European Melody Valve Trials. , 2017, JACC. Cardiovascular interventions.

[7]  Y. Boudjemline,et al.  Percutaneous pulmonary Melody® valve implantation in small conduits. , 2017, Archives of cardiovascular diseases.

[8]  J. W. Moore,et al.  Three dimensional rotational angiography for assessment of coronary arteries during melody valve implantation: introducing a technique that may improve outcomes , 2016, Netherlands Heart Journal.

[9]  R. Ringel,et al.  NuMED covered cheatham‐platinum stent™ for the treatment or prevention of right ventricular outflow tract conduit disruption during transcatheter pulmonary valve replacement , 2015, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[10]  L. Iserin,et al.  Incidence and predictors of Melody® valve endocarditis: a prospective study. , 2014, Archives of cardiovascular diseases.

[11]  Stephen G. Miller,et al.  Melody® pulmonary valve bacterial endocarditis: Experience in four pediatric patients and a review of the literature , 2014, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[12]  W. Budts,et al.  Off‐label use of percutaneous pulmonary valved stents in the right ventricular outflow tract: Time to rewrite the label? , 2013, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[13]  L. Iserin,et al.  Outcomes and safety of transcatheter pulmonary valve replacement in patients with large patched right ventricular outflow tracts. , 2012, Archives of cardiovascular diseases.

[14]  T. Kuehne,et al.  Percutaneous pulmonary valve implantation: two-centre experience with more than 100 patients. , 2011, European heart journal.

[15]  B. McCrindle,et al.  Percutaneous pulmonary valve implantation in the young 2-year follow-up. , 2010, JACC. Cardiovascular interventions.

[16]  J. Lock,et al.  Implantation of the melody transcatheter pulmonary valve in patients with a dysfunctional right ventricular outflow tract conduit early results from the u.s. Clinical trial. , 2009, Journal of the American College of Cardiology.

[17]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[18]  Z. Hijazi,et al.  Transcatheter pulmonary valve replacement: State of the art , 2016, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[19]  M. Chessa,et al.  PEDIATRIC AND CONGENITAL HEART DISEASE Original Studies Melody Transcatheter Pulmonary Valve Implantation. Results from the Registry of the Italian Society of Pediatric Cardiology , 2013 .

[20]  L. Iserin,et al.  Impact of right ventricular outflow tract size and substrate on outcomes of percutaneous pulmonary valve implantation. , 2013, Archives of cardiovascular diseases.

[21]  J. F. Keane,et al.  Bare metal stenting for obstructed small diameter homograft conduits in the right ventricular outflow tract. , 2013 .