Aortic root compression during transcatheter pulmonary valve replacement

Abstract

The majority of cases of ARC occur in patients with native/TAP RVOTs. ARC during BS/CCT may identify those at risk for ARC following TPVR. While ARC is a real phenomenon, it is unclear if it can be accurately predicted, what its clinical significance will be and how it is best avoided. Further studies are necessary to answer these questions. © 2016 Wiley Periodicals, Inc.

SAPIEN valve for percutaneous transcatheter pulmonary valve replacement without “pre‐stenting”: A multi‐institutional experience

“…Major complications included severe aortic compression ( n = 1) requiring surgical explantation and tricuspid valve injury requiring surgical intervention ( n = 2). These complications have been reported previously . There was one case of infective endocarditis 9 months after valve implantation affecting the tricuspid valve that eventually required tricuspid valve replacement.…”

Initial results from the off‐label use of the SAPIEN S3 valve for percutaneous transcatheter pulmonary valve replacement: A multi‐institutional experience

“…Each center had variable criteria for the definition of aortic compression. Notably, after the aortic compression complications seen in this study and Lindsay et al, most operators now agree that any significant deformation of the aortic root with the increase to moderate level of aortic regurgitation was a relative contraindication …”

“…As cross‐sectional imaging has a limited positive predictive value for patient selection, in this experience, balloon sizing of the landing zone was necessary prior to use of the Sapien valve in native RVOTs. Balloon sizing allows for compliance testing of the landing zone as well as testing to determine if the patient is at risk for aortic or coronary compression . It is also critical to simulate valve delivery to a landing zones close to the pulmonary artery bifurcation .…”

“…Coronary and aortic compression have been described and are of concern with TPVR in large native RVOTs . It is recommended that either rotational angiography or an aortogram in an RAO angulation be routinely performed with balloon sizing to assess for aortic compression .…”

Transcatheter valve replacement in congenital heart disease: the present and the future

“…The standard practice is to test for coronary compression using a balloon the same size as the largest stent or valve intended for use in the conduit/RVOT. Aortic compression may also occur in native RVOT interventions, but is an infrequent complication 35. While valve embolisation is a rare complication, it can usually be averted with adequate preprocedural planning and RVOT sizing.…”