Risk Stratification, Systematic Classification, and Anticipatory Management Strategies for Stent Fracture After Percutaneous Pulmonary Valve Implantation

Nordmeyer, Johannes; Khambadkone, Sachin; Coats, Louise; Schievano, Silvia; Lurz, Philipp; Parenzan, Giovanni; Taylor, Andrew M.; Lock, James E.; Bonhoeffer, Philipp

doi:10.1161/circulationaha.106.674259

Cited by 189 publications

(160 citation statements)

References 14 publications

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“…The Edwards valve has evolved over recent years, with an increased range of sizes including the 29-mm Sapien XT and, more recently, the Sapien S3 valve. Both valves are mounted on a balloon-expandable stent platform and require pre-stenting to create an optimal landing zone and reduce the chances of stent fracture or stenosis (for the Melody valve) of the framework after valve implantation [11][12][13]. For RVOT diameters >26-27 mm or patients with native RVOT post-transannular patch or very expansile RVOT, pre-stenting followed by implantation of these valves is very challenging.…”

Section: Limitation Of Currently Available Devicesmentioning

confidence: 99%

Transcatheter Pulmonary Valve Replacement: The Venus P valve-Current Status

Alkashkari¹,

AlRahimi²,

Albugami³

et al. 2018

jshd

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There is growing appreciation for the long-term adverse impact of right-sided dysfunction of the pulmonary valve in patients with congenital heart disease. Although pulmonary valve stenosis or regurgitation is often tolerated over the short and intermediate terms, the long-term consequences are numerous and include, but are not limited to, right-sided heart failure, arrhythmias, and sudden cardiac death. Surgical right ventricular outflow tract (RVOT) interventions have been performed for many decades as an initial therapy, but comorbidities associated with repeated surgeries are a concern. Transcatheter pulmonary valve replacement is safe, effective, and performed at an increasing number of centers around the world. It offers an alternative to traditional surgical techniques and may potentially alter the decision-making process whereby valvular replacement is performed prior to the development of long-term sequelae of RVOT dysfunction. However, only ~15% of potential patients with RVOT dysfunction are suitable for currently approved implantable valves (i.e., Melody valve from Medtronic and Edwards Sapien valves from Edwards Lifesciences). These two valve systems are designed and approved for patients with a conduit or bioprosthetic valve between the right ventricle and pulmonary artery, and they exclude most patients who undergo transannular patch repair techniques. The Venus P-valve (Venus Medtech, Shanghai, China) is a recently developed self-expanding transcatheter heart valve designed to adapt to a dilated RVOT and in such it provide patients with a percutaneous interventional option after tran-

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Section: Limitation Of Currently Available Devicesmentioning

confidence: 99%

Transcatheter Pulmonary Valve Replacement: The Venus P valve-Current Status

Alkashkari¹,

AlRahimi²,

Albugami³

et al. 2018

jshd

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“…The most common complication has been stent fractures which occurred in 5% to 30% of cases. (14,15,19) Although the vast majority of stent fractures remain asymptomatic, it may lead to the development of outflow tract gradients. However, this can easily be treated with the implantation of another percutaneous valve.…”

Section: Coronary Compression Was Responsible For Virtually All Deathsmentioning

confidence: 99%

Right ventricular outfl ow tract revalvulation using the Melody Valve: The next frontier

Buys

Brown

2017

SAHJ

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Right ventricular outfl ow tract revalvulation using the Melody Valve: The next frontier in terms of years of freedom from re-operation. Freedom from re-operation varies (see Table I) with rates of 97% at one year to, on average, 70% and 31% after 10 and 15 years respectively.(1-3) Low body weight, younger age at insertion, small size grafts and longer cross-clamping times are factors associated with early graft failure.(1,4) It has been estimated that these patients may require up to 5 conduit revisions over a lifetime.Multiple conduit revisions in these patients often result in prolonged hospital stays, increased morbidity and mortality due to the fact that difficulty of surgery increases with every re-operation. This may result in a considerable increase in medical costs and a negative impact on quality of life. Nevertheless, surgery has good long term survival and should be considered as the gold standard of treatment. PERCUTANEOUS RVOT REVALVULATIONUntil recently, surgery was the only option for managing RVOT dysfunction. The first percutaneous pulmonary valve was implanted

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“…Another problem that can require reintervention is stent fracture, which has been reported to be as high as 43% without bare-metal stenting of the RVOT [31]. Nordmeyer et al [32] reported a 75% freedom from Melody stent fracture (MSF) at 2 years in the native RVOT. In the multicenter trial for Melody valve implantation [16], short and medium-term follow-up data demonstrated that the freedom from stent fracture was 83.7% ± 3.7% at 7.5 months and 77.8% ± 4.3% at 14 months.…”

Section: Potential Complicationsmentioning

confidence: 99%

“…The median follow up was 30 months. MSF was classified into three types according to Nordmeyer et al [32]: type 1, fracture of one or more strut without loss of stent integrity; type 2, fracture with loss of stent integrity; and type 3, fracture associated with separation of fragments or embolization. Thirtynine out of 150 patients were diagnosed with MSF; 33 patients were classified as type I.…”

Section: Potential Complicationsmentioning

confidence: 99%