Journal article

Publication year: 2019

Pages: 107-113

Journal: Translational Pediatrics

Volume number: 8

Issue number: 2

ISSN: 2224-4336

eISSN: 2224-4344

Open access status: Gold

DOI Link: https://doi.org/10.21037/tp.2019.04.02

Publisher: AME Publishing

Abstract: 

Background: Percutaneous pulmonary valve implantation (PPVI) has been established as a safe and effective alternative to surgery treating patients with a failing pulmonary valve conduit. Nevertheless, the majority of patients in need of a valve have a native, non-obstructive right ventricular outflow tract (RVOT). The current approved stent-valves have a balloon-expandable design. Pre-stenting of the RVOT to create a landing zone and also protect the valve stability is usually mandatory; large, non-obstructive RVOTs need pre-stenting to reduce the RVOT-diameter for a balloon-expandable valve implantation.

Methods: A retrospective study design was used to analyze the medium-term outcome after PPVI in a series of 26 patients with native or reconstructed RVOT.

Results: PPVI was successfully performed in all, but 1 (96%). Within the follow-up of a minimum of 2 years, the percutaneous implanted valves remained competent; a significant pressure gradient was not detected. Furthermore, no PPVI-related complications such as endocarditis, migration or stent fractures were observed. The electrocardiogram at rest, in particular the QRS duration remained unchanged immediate post-PPVI as well as at medium-term follow-up of 24 months. However, ventricular arrhythmias were documented in 3 patients (11.5%); all patients were successfully treated with antiarrhythmic drugs, utilizing metoprolol. A trial of an invasive catheter based RVOT-ablation in one remained unsuccessful; pre-stented RVOT did not allow a successful intervention.

Conclusions: Medium-term follow-up showed excellent results of the mechanical valve function. PPVI utilizing balloon-expandable stent-valves in a native RVOT remains an off-label use. Despite our encouraging results, advanced manipulations of the patched or native RVOT might be associated with significant ventricular arrhythmias. There is a need for less invasive RVOT reduction devices.

Harvard Citation style: Esmaeili, A., Khalil, M., Behnke-Hall, K., Gonzalez y Gonzalez, M., Kerst, G., Fichtlscherer, S., et al. (2019) Percutaneous pulmonary valve implantation (PPVI) in non-obstructive right ventricular outflow tract: limitations and mid-term outcomes, Translational Pediatrics, 8(2), pp. 107-113. https://doi.org/10.21037/tp.2019.04.02

APA Citation style: Esmaeili, A., Khalil, M., Behnke-Hall, K., Gonzalez y Gonzalez, M., Kerst, G., Fichtlscherer, S., Akintuerk, H., & Schranz, D. (2019). Percutaneous pulmonary valve implantation (PPVI) in non-obstructive right ventricular outflow tract: limitations and mid-term outcomes. Translational Pediatrics. 8(2), 107-113. https://doi.org/10.21037/tp.2019.04.02