Percutaneous pulmonary valve implantation – state of the art and Polish experience

Abstract

Percutaneous pulmonary valve implantation (PPVI) is a relatively new method of treating patients with right ventricular outflow tract (RVOT) dysfunction after surgical repair of congenital heart disease. Since its introduction in 2000 by Bonhoeffer, more than ten thousand PPVI procedures have been performed worldwide. Indications for PPVI have been adapted from those accepted for surgical intervention. Two types of valves are being used: Melody Medtronic available in diameters 16 mm and 18 mm and the family of Edwards SAPIEN valves 23, 26 and 29. The procedure has been shown to be feasible and safe when performed in patients with full pulmonary conduit dysfunction and in selected cases of patched RVOT. The low complication rate and the reduced number of open-chest re-interventions over a patient’s lifetime are among the main advantages of the procedure. The most important problem responsible for late mortality and reinterventions is infective endocarditis. Size restrictions of the currently available valves limit deployment in the majority of patients with a wide RVOT. Newer devices are being developed to make these patients suitable for PPVI. A literature review, Polish experience and results of PPVI performed in 66 patients in the Institute of Cardiology in Warsaw are briefly reported.

Risk factors for infective endocarditis following transcatheter pulmonary valve replacement in patients with congenital heart disease

“…It is imperative to identify pre, intra, and postvalve implant factors that may identify those at the highest and lowest risk for the development of IE. Inadequate dental hygiene as well as lack of prophylaxis for dental and invasive procedures, intravenous therapy or drug use, piercings, tattoo, and nail biting are among some of the more established risk factors for IE as these practices facilitate the entry of bacteria into the bloodstream . Published studies have suggested that patients with non‐native RVOT anatomy, residual stenosis post‐TCPVR, those with prior history of endocarditis, and those that have undergone Melody™ jugular venous valve placement are at increased risk for the development of IE .…”

Tricuspid regurgitation as a complication of Edwards Sapien XT valve implantation in pulmonary position a problem to deal with

“…Since the first PPVI by Bonhoeffer et al in 2000 , more than 10,000 procedures have been performed all around the world, with an increasing experience that has confirmed that PPVI is a valuable alternative to surgery . Being an interventional procedure, acute complications may occur and include coronary compression by the stent or the prosthesis, aortic root deformation, partial or total conduit rupture, guidewire related injuries of distal pulmonary artery branches, valve or stent migration, acute flash pulmonary oedema, and vascular access site damages .…”

“…PPVI is usually preceded by pre-stenting, especially when treating "native" RVOT dysfunction, in order to create an adequate landing zone for the valve. Different pre-stenting techniques can be adopted.They include the "Russian doll technique," the "jailing technique," the "Russian jailing technique," and the "telescopic technique" [5].Since the first PPVI by Bonhoeffer et al in 2000 [6], more than 10,000 procedures have been performed all around the world, with an increasing experience that has confirmed that PPVI is a valuable alternative to surgery [7]. Being an interventional procedure, acute complications may occur and include coronary compression by the stent or the prosthesis, aortic root deformation, partial or total conduit rupture, guidewire related injuries of distal pulmonary artery branches, valve or stent migration, acute flash pulmonary oedema, and vascular access site damages [8][9][10][11].Here, we report on a new complication that occurred in three of our patients undergoing Edwards-Sapien Valve implantation.…”

Percutaneous pulmonary valve implantation in grown‐up congenital heart disease patients: Insights from the Zurich experience

“…For example, routine RVOT pre‐stenting, careful attention to any coronary artery compression, and strictly aseptic manipulations of the valved conduit have improved the outcomes. Studies have shown that PPVI is highly effective in reducing either stenosis or regurgitation of the RVOT . Although several studies have shown reductions in right ventricular dimensions, improvement of right ventricular function and patients’ functional capacity, the optimal timing for intervention remains under debate, particularly in patients with pure pulmonary regurgitation.…”

“…Studies have shown that PPVI is highly effective in reducing either stenosis or regurgitation of the RVOT. [4][5][6][7][8][9][10][11][12][13][14] Although several studies have shown reductions in right ventricular dimensions, improvement of right ventricular function and patients' functional capacity, the optimal timing for intervention remains under debate, particularly in patients with pure pulmonary regurgitation. As data on efficacy and long-term clinical performance after PPVI is still limited, the aim of the present report was to evaluate indication, procedural success, complications, echocardio-…”