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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)CC

Abstract

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.

Authors+Show Affiliations

From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.). wendywhiteside@gmail.com.From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).From the Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., J.T.T., C.M.M., B.H.G.); Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, Los Angeles, CA (J.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Children's Hospital (O.A.); Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor (A.K.A., M.L.B.); Division of Cardiology, the Children's Hospital of Philadelphia, PA (M.J.G.); Seattle Children's Hospital, University of Washington (T.K.J.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Division of Cardiology, UCSF Benioff Children's Hospital, University of California (J.J.M.); Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York Presbyterian (M.E.T.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (T.Z.).

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

28851718

Citation

Whiteside, Wendy, et al. "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." Circulation. Cardiovascular Interventions, vol. 10, no. 9, 2017.
Whiteside W, Tretter JT, Aboulhosn J, et al. 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;10(9).
Whiteside, W., Tretter, J. T., Aboulhosn, J., Aldoss, O., Armstrong, A. K., Bocks, M. L., Gillespie, M. J., Jones, T. K., Martin, M. H., Meadows, J. J., Metcalf, C. M., Turner, M. E., Zellers, T., & Goldstein, B. H. (2017). 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. Circulation. Cardiovascular Interventions, 10(9). https://doi.org/10.1161/CIRCINTERVENTIONS.116.004730
Whiteside W, et al. 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;10(9) PubMed PMID: 28851718.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Whiteside,Wendy, AU - Tretter,Justin T, AU - Aboulhosn,Jamil, AU - Aldoss,Osamah, AU - Armstrong,Aimee K, AU - Bocks,Martin L, AU - Gillespie,Matthew J, AU - Jones,Thomas K, AU - Martin,Mary Hunt, AU - Meadows,Jeffrey J, AU - Metcalf,Christina M, AU - Turner,Mariel E, AU - Zellers,Thomas, AU - Goldstein,Bryan H, PY - 2016/11/09/received PY - 2017/07/10/accepted PY - 2017/8/31/entrez PY - 2017/8/31/pubmed PY - 2018/5/22/medline KW - catheterization KW - pulmonary valve KW - pulmonary valve insufficiency KW - transposition of great vessels JF - Circulation. Cardiovascular interventions JO - Circ Cardiovasc Interv VL - 10 IS - 9 N2 - 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. SN - 1941-7632 UR - https://www.unboundmedicine.com/medline/citation/28851718/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_ DB - PRIME DP - Unbound Medicine ER -