Hybrid approach for harmony transcatheter pulmonary valve replacement

Shibbani, Kamel; Aboulhosn, Jamil; Levi, Daniel S.; Nijres, Bassel Mohammad; Blais, Benjamin A.; Karimi, Mohsen; Arsdell, Glen Van; Aldoss, Osamah

doi:10.1002/ccd.30504

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…For this study, we analyzed all patients who underwent percutaneous TPVR with a TPV25 despite not meeting the recommended oversizing criteria for the implanted valve. Patients who underwent a hybrid surgical Harmony valve implant 8 were excluded.…”

Section: Methodsmentioning

confidence: 99%

Transcatheter Pulmonary Valve Replacement With the Harmony Valve in Patients Who Do Not Meet Recommended Oversizing Criteria on the Screening Perimeter Plot

McElhinney,

Gillespie,

Aboulhosn

et al. 2024

Circ: Cardiovascular Interventions

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BACKGROUND: Anatomic selection for Harmony valve implant is determined with the aid of a screening report and perimeter plot (PP) that depicts the perimeter-derived radius along the right ventricular outflow tract (RVOT) and projects device oversizing. The PP provides an estimation of suitability for implant, but its sensitivity as a screening method is unknown. This study was performed to describe anatomic features and outcomes in patients who underwent Harmony TPV25 implant despite a PP that predicted inadequate oversizing. METHODS: We reviewed RVOT anatomic features and measurements in patients who underwent transcatheter pulmonary valve replacement with the Harmony TPV25 device despite a PP that predicted inadequate oversizing. RESULTS: This study included 22 patients. There were no unsuccessful implants or adverse valve-related events. Anatomic features varied, but all patients fit into 1 of 3 anatomic types characterized by differences in RVOT dimensions. Type 1 patients (n=9) had a long RVOT with a choke point and a wide main pulmonary artery. Type 2 patients (n=6) had a short RVOT that was pyramidal in shape, with no choke point, and extensive main pulmonary artery lengthening/expansion during systole. Type 3 patients (n=7) had a short, bulbous main pulmonary artery with a choke point and an open pulmonary artery bifurcation. CONCLUSIONS: Transcatheter pulmonary valve replacement with the Harmony valve is feasible in some patients whose PP fit analysis predicts inadequate oversizing. All cases in this series fit into 1 of 3 anatomic patterns, which are not identified in the screening report. Implanters must review cases individually to assess the feasibility of the implant.

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Section: Methodsmentioning

confidence: 99%

Transcatheter Pulmonary Valve Replacement With the Harmony Valve in Patients Who Do Not Meet Recommended Oversizing Criteria on the Screening Perimeter Plot

McElhinney,

Gillespie,

Aboulhosn

et al. 2024

Circ: Cardiovascular Interventions

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“…After confirming proper position of the valve, the delivery sheath is removed and the stay sutures are tightened and the puncture site in the RV anterior wall is repaired. The advantage to this procedure is avoiding cardiopulmonary bypass and shorter procedure and hospital stay times [53]. The use of the hybrid approach should be part of the armamentarium of all congenital heart disease programs that take care of patients of all ages with congenital heart disease.…”

Section: Hybrid and Periventricular Delivery Of Tpv In Smaller Patien...mentioning

confidence: 99%

Unmet Clinical Needs for Transcatheter Pulmonary Valves

2023

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A common feature of congenital heart disease is the presence of right ventricular outflow tract (RVOT) obstruction that can range from mild to severe and can lead to atresia of the pulmonary valve, in extreme conditions. RVOT abnormalities can frequently be corrected surgically or via interventional means. However, most of these patients will ultimately develop pulmonary valve insufficiency and eventual right ventricular dilation, which will require a pulmonary valve replacement at some point in their life to mitigate the detrimental effects of pulmonary valve regurgitation (PVR) on the right ventricle (RV). The evolution from the studies done by Philip Bonhoeffer to implant a pulmonary valve via transcatheter means, have provided a bedrock for transcatheter pulmonary valve replacement (TPVR). Yet, several areas of unmet need for a demographic of patients still exist. Here, we discuss the clinical unmet needs in children under 20 Kg and expand the use of hybrid and other TPVR approaches along with the current indications and contraindications for pulmonary valve replacement. The constraints and limitations from commercially available pulmonary valves will be discussed from a clinical standpoint. Finally, we explore the use of hybrid and periventricular delivery of transcatheter pulmonary valves in younger patients.

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“…Modifying the RVOT via a hybrid approach can be an alternative, but this option can also be limited in certain patients. [4][5][6][7] In this report, we describe a case in whom a surgical modification of the RVOT via a hybrid approach failed with the subsequent successful placement of two Harmony™ valves in the bilateral branch pulmonary arteries.…”

Section: Introductionmentioning

confidence: 99%

“…However, a group of patients with severe RVOT dilatation remains challenging, as even self‐expanding valves may not be safely placed due to inadequate interference with the RVOT. Modifying the RVOT via a hybrid approach can be an alternative, but this option can also be limited in certain patients 4‐7 …”

Section: Introductionmentioning

confidence: 99%