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Percutaneous Edwards SAPIEN(™) valve implantation for significant pulmonary regurgitation after previous surgical repair with a right ventricular outflow patch.
Catheter Cardiovasc Interv. 2014 Feb 15; 83(3):474-81.CC

Abstract

BACKGROUND

Current indications for percutaneous pulmonary valve implantation (PPVI) are limited to patients who had their outflow tracts repaired with the use of a "full" condui-homograft. Patients after a patch repair are believed to have an unfavorable anatomy for PPVI.

OBJECTIVES

To evaluate a novel use of Edwards SAPIEN(TM) valve for percutaneous treatment of moderate and severe pulmonary regurgitation after tetralogy of Fallot (TF) repair with a right ventricular outflow (RVOT) patch.

METHODS

PPVI was intended in 10 patients (age 21-39 years, 2 ♂) with regurgitant fraction of 30-59%, measured by cardiac magnetic resonance imaging (CMRI) 16-30 years after repair with a RVOT patch. Balloon test-inflations were used for definitive measurements and location of the landing site for the valve. All RVOTs were prestented.

RESULTS

Successful valve implantation was achieved in nine patients. In one patient a bare-metal stent used for prestenting embolized into pulmonary artery. A 26-mm valve was implanted in seven and a 23-mm in two patients. CMRI at 1-2 month follow-up (n = 8) demonstrated both, sustained relief of pulmonary incompetence (regurgitant fraction = 0-14%) and significant decrease of the right ventricular end-diastolic volume indexes (from 169.9 ± 43.8 to 140.0 ± 40.3 ml/m(2) , P < 0.001). At that follow-up no adverse event occurred. No stent fractures were observed.

CONCLUSIONS

We report the first case series of patients with significant PR after a RVOT patch repair, successfully treated with a percutaneous Edwards SAPIEN(TM) valve implantation. The procedure is technically feasible and may be offered to patients with the outflow tracts larger than those limited by the Melody(®) system available currently.

Authors+Show Affiliations

Department of Coronary and Structural Heart Diseases, Institute of Cardiology, 04-628 Warszawa, Alpejska 42, Poland.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 availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23804542

Citation

Demkow, Marcin, et al. "Percutaneous Edwards SAPIEN(™) Valve Implantation for Significant Pulmonary Regurgitation After Previous Surgical Repair With a Right Ventricular Outflow Patch." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 83, no. 3, 2014, pp. 474-81.
Demkow M, Rużyłło W, Biernacka EK, et al. Percutaneous Edwards SAPIEN(™) valve implantation for significant pulmonary regurgitation after previous surgical repair with a right ventricular outflow patch. Catheter Cardiovasc Interv. 2014;83(3):474-81.
Demkow, M., Rużyłło, W., Biernacka, E. K., Kalińczuk, Ł., Spiewak, M., Kowalski, M., Sitkowska, E., Kuśmierczyk, M., Różanski, J., Banaś, S., Chmielak, Z., & Hoffman, P. (2014). Percutaneous Edwards SAPIEN(™) valve implantation for significant pulmonary regurgitation after previous surgical repair with a right ventricular outflow patch. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 83(3), 474-81. https://doi.org/10.1002/ccd.25096
Demkow M, et al. Percutaneous Edwards SAPIEN(™) Valve Implantation for Significant Pulmonary Regurgitation After Previous Surgical Repair With a Right Ventricular Outflow Patch. Catheter Cardiovasc Interv. 2014 Feb 15;83(3):474-81. PubMed PMID: 23804542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous Edwards SAPIEN(™) valve implantation for significant pulmonary regurgitation after previous surgical repair with a right ventricular outflow patch. AU - Demkow,Marcin, AU - Rużyłło,Witold, AU - Biernacka,Elżbieta Katarzyna, AU - Kalińczuk,Łukasz, AU - Spiewak,Mateusz, AU - Kowalski,Mirosław, AU - Sitkowska,Ewa, AU - Kuśmierczyk,Mariusz, AU - Różanski,Jacek, AU - Banaś,Sławomir, AU - Chmielak,Zbigniew, AU - Hoffman,Piotr, Y1 - 2013/07/19/ PY - 2012/08/20/received PY - 2013/09/17/revised PY - 2013/06/16/accepted PY - 2013/6/28/entrez PY - 2013/6/28/pubmed PY - 2014/10/9/medline KW - cardiac magnetic resonance KW - prestenting KW - tetralogy of Fallot SP - 474 EP - 81 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 83 IS - 3 N2 - BACKGROUND: Current indications for percutaneous pulmonary valve implantation (PPVI) are limited to patients who had their outflow tracts repaired with the use of a "full" condui-homograft. Patients after a patch repair are believed to have an unfavorable anatomy for PPVI. OBJECTIVES: To evaluate a novel use of Edwards SAPIEN(TM) valve for percutaneous treatment of moderate and severe pulmonary regurgitation after tetralogy of Fallot (TF) repair with a right ventricular outflow (RVOT) patch. METHODS: PPVI was intended in 10 patients (age 21-39 years, 2 ♂) with regurgitant fraction of 30-59%, measured by cardiac magnetic resonance imaging (CMRI) 16-30 years after repair with a RVOT patch. Balloon test-inflations were used for definitive measurements and location of the landing site for the valve. All RVOTs were prestented. RESULTS: Successful valve implantation was achieved in nine patients. In one patient a bare-metal stent used for prestenting embolized into pulmonary artery. A 26-mm valve was implanted in seven and a 23-mm in two patients. CMRI at 1-2 month follow-up (n = 8) demonstrated both, sustained relief of pulmonary incompetence (regurgitant fraction = 0-14%) and significant decrease of the right ventricular end-diastolic volume indexes (from 169.9 ± 43.8 to 140.0 ± 40.3 ml/m(2) , P < 0.001). At that follow-up no adverse event occurred. No stent fractures were observed. CONCLUSIONS: We report the first case series of patients with significant PR after a RVOT patch repair, successfully treated with a percutaneous Edwards SAPIEN(TM) valve implantation. The procedure is technically feasible and may be offered to patients with the outflow tracts larger than those limited by the Melody(®) system available currently. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/23804542/Percutaneous_Edwards_SAPIEN_™__valve_implantation_for_significant_pulmonary_regurgitation_after_previous_surgical_repair_with_a_right_ventricular_outflow_patch_ L2 - https://doi.org/10.1002/ccd.25096 DB - PRIME DP - Unbound Medicine ER -