Intentional Fracture of Bioprosthetic Valve Frames in Patients Undergoing Valve-in-Valve Transcatheter Pulmonary Valve Replacement

被引：44

作者：

Shahanavaz, Shabana ^{[1
]}

Asnes, Jeremy D. ^{[2
]}

Grohmann, Jochen ^{[3
]}

Qureshi, Athar M. ^{[4
]}

Rome, Jonathan J. ^{[5
]}

Tanase, Daniel ^{[6
]}

Crystal, Matthew A. ^{[7
]}

Latson, Larry A. ^{[8
]}

Morray, Brian H. ^{[9
]}

Hellenbrand, William ^{[2
]}

Balzer, David T. ^{[1
]}

Gewillig, Marc ^{[10
]}

Love, Jon C. ^{[11
]}

Berdjis, Farhouch ^{[12
]}

Gillespie, Matthew J. ^{[5
]}

McElhinney, Doff B. ^{[13
,14
]}

机构：

[1] Washington Univ, Dept Pediat, Div Cardiol, Sch Med, St Louis, MO 63110 USA

[2] Yale Univ, New Haven, CT USA

[3] Univ Freiburg, Heart Ctr, Dept Congenital Heart Defects & Pediat Cardiol, Freiburg, Germany

[4] Baylor Coll Med, Texas Childrens Hosp, Lillie Frank Abercrombie Sect Cardiol, Houston, TX 77030 USA

[5] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[6] German Heart Ctr, Dept Paediat Cardiol & Congenital Heart Defects, Munich, Germany

[7] Columbia Univ, Med Ctr, Morgan Stanley Childrens Hosp, Div Pediat Cardiol, New York, NY USA

[8] Joe DiMaggio Childrens Hosp, Dept Cardiol, Hollywood, FL USA

[9] Univ Washington, Sch Med, Seattle Childrens Hosp, Div Pediat Cardiol, Seattle, WA 98195 USA

[10] Univ Hosp Leuven, Dept Pediat Cardiol, Leuven, Belgium

[11] Univ New Mexico, Div Pediat Cardiol, Albuquerque, NM 87131 USA

[12] Childrens Hosp Orange Cty, Orange, CA 92668 USA

[13] Stanford Univ, Sch Med, Dept Pediat, Lucile Packard Childrens Hosp Heart Ctr, Palo Alto, CA 94304 USA

[14] Stanford Univ, Sch Med, Dept Cardiothorac Surg, Lucile Packard Childrens Hosp Heart Ctr, Palo Alto, CA 94304 USA

来源：

CIRCULATION-CARDIOVASCULAR INTERVENTIONS | 2018年 / 11卷 / 08期

关键词：

hemodynamics; prostheses and implants; pulmonary valve; stents; tetralogy of Fallot; CONGENITAL HEART-DISEASE; PERIMOUNT BIOPROSTHESIS; MULTICENTER EXPERIENCE; RISK-FACTORS; IMPLANTATION; DEGENERATION; PLACEMENT; MISMATCH; POSITION; CRACKING;

D O I：

10.1161/CIRCINTERVENTIONS.118.006453

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Percutaneous transcatheter pulmonary valve replacement (TPVR) has good clinical and hemodynamic outcomes in treating dysfunctional bioprosthetic valves (BPV) in the pulmonary position. Valve-in-valve therapy can further decrease the inner diameter (ID), potentially resulting in patient-prosthesis mismatch in patients with smaller BPVs. METHODS AND RESULTS: To evaluate feasibility and outcomes of intentional BPV fracture to enlarge the pulmonary valve orifice with TPVR, 37 patients from 13 centers who underwent TPVR with intended BPV fracture were evaluated. A control cohort (n=70) who underwent valve-in-valve TPVR without attempted fracture was evaluated. BPV was successfully fractured in 28 patients and stretched in 5 while fracture was unsuccessful in 4. A Melody valve was implanted in 25 patients with fractured/stretched frame and a Sapien (XT 3) valve in 8. Among patients whose BPV was fractured/stretched, the final ID was a median of 2 mm larger (0-6.5 mm) than the valve's true ID. The narrowest diameter after TPVR in controls was a median of 2 mm smaller (P<0.001) than true ID. Right ventricular outflow tract gradient decreased from median 40 to 8 mmHg in the fracture group. Cases with fracture/stretching were matched 1:1 (weight, true ID) to controls. Post-TPVR peak gradient was lower but not significant (8.35.2 versus 11.8 +/- 9.2 mmHg; P=0.070). There were no fracture-related adverse events. CONCLUSIONS: Preliminary experience shows intentional fracture of BPV frame can be useful for achieving larger ID and better hemodynamics after valve-in-valve TPVR.

引用

页数：12