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Percutaneous pulmonary valve-in-valve implantation: a successful treatment concept for early device failure.
Eur Heart J. 2008 Mar; 29(6):810-5.EH

Abstract

AIMS

Percutaneous pulmonary valve implantation (PPVI) is now an accepted treatment strategy for right ventricular (RV) outflow tract (RVOT) dysfunction in many European Heart Centres. We analysed the efficacy of repeat PPVI as a treatment modality for early device failure.

METHODS AND RESULTS

Twenty patients underwent repeat PPVI for RVOT obstruction because of early device failure ('Hammock effect', 'Hammock-like effect', stent fracture, residual stenosis). Repeat PPVI was feasible in all patients with no procedural complications. Following implantation of a second device, catheter-measured RVOT gradient and RV systolic pressure fell significantly (RVOT gradient: 46.1 +/- 3.9 to 18.1 +/- 2.4 mmHg, P < 0.001; RVSP: 70.9 +/- 4.8 to 46.1 +/- 2.6 mmHg, P < 0.001), in all but one patient (15 years, male, common arterial trunk, 11.5 mm homograft). During follow-up, four of 20 required re-intervention [third PPVI for stent fracture (n = 2), device explantation: external compression by the sternum (n = 1), endocarditis (n = 1)], and one of the 20 is awaiting surgical management. In the remainder, second PPVI resulted in a sustained improvement in haemodynamics with a mean follow-up of 10.9 +/- 3.0 months. In this series, the probability of freedom from re-intervention at 2 years was higher after second PPVI when compared with the index procedure (89.4 vs. 20.0%, P < 0.001).

CONCLUSION

Repeat PPVI is an effective treatment for early device failure in defined conditions and leads to improved freedom from re-intervention.

Authors+Show Affiliations

Cardiothoracic Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London WC1N 3JH, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18316357

Citation

Nordmeyer, Johannes, et al. "Percutaneous Pulmonary Valve-in-valve Implantation: a Successful Treatment Concept for Early Device Failure." European Heart Journal, vol. 29, no. 6, 2008, pp. 810-5.
Nordmeyer J, Coats L, Lurz P, et al. Percutaneous pulmonary valve-in-valve implantation: a successful treatment concept for early device failure. Eur Heart J. 2008;29(6):810-5.
Nordmeyer, J., Coats, L., Lurz, P., Lee, T. Y., Derrick, G., Rees, P., Cullen, S., Taylor, A. M., Khambadkone, S., & Bonhoeffer, P. (2008). Percutaneous pulmonary valve-in-valve implantation: a successful treatment concept for early device failure. European Heart Journal, 29(6), 810-5. https://doi.org/10.1093/eurheartj/ehn073
Nordmeyer J, et al. Percutaneous Pulmonary Valve-in-valve Implantation: a Successful Treatment Concept for Early Device Failure. Eur Heart J. 2008;29(6):810-5. PubMed PMID: 18316357.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous pulmonary valve-in-valve implantation: a successful treatment concept for early device failure. AU - Nordmeyer,Johannes, AU - Coats,Louise, AU - Lurz,Philipp, AU - Lee,Twin-Yen, AU - Derrick,Graham, AU - Rees,Philipp, AU - Cullen,Seamus, AU - Taylor,Andrew M, AU - Khambadkone,Sachin, AU - Bonhoeffer,Philipp, Y1 - 2008/03/03/ PY - 2008/3/5/pubmed PY - 2008/11/4/medline PY - 2008/3/5/entrez SP - 810 EP - 5 JF - European heart journal JO - Eur Heart J VL - 29 IS - 6 N2 - AIMS: Percutaneous pulmonary valve implantation (PPVI) is now an accepted treatment strategy for right ventricular (RV) outflow tract (RVOT) dysfunction in many European Heart Centres. We analysed the efficacy of repeat PPVI as a treatment modality for early device failure. METHODS AND RESULTS: Twenty patients underwent repeat PPVI for RVOT obstruction because of early device failure ('Hammock effect', 'Hammock-like effect', stent fracture, residual stenosis). Repeat PPVI was feasible in all patients with no procedural complications. Following implantation of a second device, catheter-measured RVOT gradient and RV systolic pressure fell significantly (RVOT gradient: 46.1 +/- 3.9 to 18.1 +/- 2.4 mmHg, P < 0.001; RVSP: 70.9 +/- 4.8 to 46.1 +/- 2.6 mmHg, P < 0.001), in all but one patient (15 years, male, common arterial trunk, 11.5 mm homograft). During follow-up, four of 20 required re-intervention [third PPVI for stent fracture (n = 2), device explantation: external compression by the sternum (n = 1), endocarditis (n = 1)], and one of the 20 is awaiting surgical management. In the remainder, second PPVI resulted in a sustained improvement in haemodynamics with a mean follow-up of 10.9 +/- 3.0 months. In this series, the probability of freedom from re-intervention at 2 years was higher after second PPVI when compared with the index procedure (89.4 vs. 20.0%, P < 0.001). CONCLUSION: Repeat PPVI is an effective treatment for early device failure in defined conditions and leads to improved freedom from re-intervention. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/18316357/Percutaneous_pulmonary_valve_in_valve_implantation:_a_successful_treatment_concept_for_early_device_failure_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehn073 DB - PRIME DP - Unbound Medicine ER -