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Utility of the Medtronic microvascular plug™ as a transcatheter implantable and explantable pulmonary artery flow restrictor in a swine model.
Catheter Cardiovasc Interv 2019; 93(7):1320-1328CC

Abstract

BACKGROUND

A surgical pulmonary artery band (PAB) is used to control excessive pulmonary blood flow for certain congenital heart diseases. Previous attempts have been made to develop a transcatheter, implantable pulmonary flow restrictor (PFR) without great success. We modified a microvascular plug (MVP) to be used as a PFR. The objectives of this study were to demonstrate feasibility of transcatheter implantation and retrieval of the modified MVP as a PFR, and compare PA growth while using the PFR versus PAB.

METHODS AND RESULTS

The PFR was implanted in eight newborn piglets in bilateral branch pulmonary arteries (PAs). Immediately post-PFR implantation, the right ventricular systolic pressure increased from a median of 20-51 mmHg. Transcatheter retrieval of PFR was 100% successful at 3, 6, and 9 weeks and 50% at 12-weeks post-implant. A left PAB was placed via thoracotomy in four other newborn piglets. Debanding was performed 6-weeks later via balloon angioplasty. On follow-up, the proximal left PA diameters in the PFR and the PAB groups were similar (median 8 vs. 7.1 mm; p = 0.11); albeit the surgical band sites required repeat balloon angioplasty secondary to recurrent stenosis. By histopathology, there was grade II vessel injury in two pigs immediately post-retrieval of PFR that healed by 12 weeks.

CONCLUSIONS

Transcatheter implantation and retrieval of the MVP as a PFR is feasible. PA growth is comparable to surgical PAB, which is likely to require reinterventions. The use of the MVP as a PFR in humans has to be trialed before recommending its routine use.

Authors+Show Affiliations

Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee.Department of Pathology, University of Tennessee Health Science Center, Memphis, Tennessee.Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee.Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30828988

Citation

Khan, Abdul H., et al. "Utility of the Medtronic Microvascular Plug™ as a Transcatheter Implantable and Explantable Pulmonary Artery Flow Restrictor in a Swine Model." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 93, no. 7, 2019, pp. 1320-1328.
Khan AH, Hoskoppal D, Kumar TKS, et al. Utility of the Medtronic microvascular plug™ as a transcatheter implantable and explantable pulmonary artery flow restrictor in a swine model. Catheter Cardiovasc Interv. 2019;93(7):1320-1328.
Khan, A. H., Hoskoppal, D., Kumar, T. K. S., Bird, L., Allen, K., Lloyd, H., ... Sathanandam, S. (2019). Utility of the Medtronic microvascular plug™ as a transcatheter implantable and explantable pulmonary artery flow restrictor in a swine model. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 93(7), pp. 1320-1328. doi:10.1002/ccd.28162.
Khan AH, et al. Utility of the Medtronic Microvascular Plug™ as a Transcatheter Implantable and Explantable Pulmonary Artery Flow Restrictor in a Swine Model. Catheter Cardiovasc Interv. 2019 Jun 1;93(7):1320-1328. PubMed PMID: 30828988.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of the Medtronic microvascular plug™ as a transcatheter implantable and explantable pulmonary artery flow restrictor in a swine model. AU - Khan,Abdul H, AU - Hoskoppal,Deepthi, AU - Kumar,T K Susheel, AU - Bird,Lindsey, AU - Allen,Kimberly, AU - Lloyd,Hannah, AU - Knott-Craig,Christopher J, AU - Waller,B Rush, AU - Sathanandam,Shyam, Y1 - 2019/03/03/ PY - 2018/06/30/received PY - 2018/11/24/revised PY - 2019/02/09/accepted PY - 2019/3/5/pubmed PY - 2019/3/5/medline PY - 2019/3/5/entrez KW - animal models KW - coil/device/transcatheter KW - congenital heart disease KW - embolization KW - foreign body retrieval KW - interventional devices/innovation KW - pediatric intervention KW - pediatrics SP - 1320 EP - 1328 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 93 IS - 7 N2 - BACKGROUND: A surgical pulmonary artery band (PAB) is used to control excessive pulmonary blood flow for certain congenital heart diseases. Previous attempts have been made to develop a transcatheter, implantable pulmonary flow restrictor (PFR) without great success. We modified a microvascular plug (MVP) to be used as a PFR. The objectives of this study were to demonstrate feasibility of transcatheter implantation and retrieval of the modified MVP as a PFR, and compare PA growth while using the PFR versus PAB. METHODS AND RESULTS: The PFR was implanted in eight newborn piglets in bilateral branch pulmonary arteries (PAs). Immediately post-PFR implantation, the right ventricular systolic pressure increased from a median of 20-51 mmHg. Transcatheter retrieval of PFR was 100% successful at 3, 6, and 9 weeks and 50% at 12-weeks post-implant. A left PAB was placed via thoracotomy in four other newborn piglets. Debanding was performed 6-weeks later via balloon angioplasty. On follow-up, the proximal left PA diameters in the PFR and the PAB groups were similar (median 8 vs. 7.1 mm; p = 0.11); albeit the surgical band sites required repeat balloon angioplasty secondary to recurrent stenosis. By histopathology, there was grade II vessel injury in two pigs immediately post-retrieval of PFR that healed by 12 weeks. CONCLUSIONS: Transcatheter implantation and retrieval of the MVP as a PFR is feasible. PA growth is comparable to surgical PAB, which is likely to require reinterventions. The use of the MVP as a PFR in humans has to be trialed before recommending its routine use. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/30828988/Utility_of_the_Medtronic_microvascular_plug™_as_a_transcatheter_implantable_and_explantable_pulmonary_artery_flow_restrictor_in_a_swine_model L2 - https://doi.org/10.1002/ccd.28162 DB - PRIME DP - Unbound Medicine ER -