The future of transcatheter pulmonary valvulation

Abstract

Percutaneous pulmonary valve implantation now has a key role in the setting of dysfunctional right ventricle-to-pulmonary artery conduits or failing bioprosthetic pulmonary valves. However, despite the excellent results obtained with the two devices available currently (the Melody(®) valve [Medtronic Inc., Minneapolis, MN, USA] and the Edwards SAPIEN(®) valve [Edwards Lifesciences, Irvine, CA, USA]), many patients eligible for pulmonary valve replacement remain unsuitable for percutaneous pulmonary valve implantation, mainly because of large native outflow tracts. Accordingly, one of the major challenges for the future is to expand percutaneous pulmonary valve implantation to a broader population of patients. Moving forward, there is important ongoing research that is intended to improve patient outcomes, expand percutaneous pulmonary valve implantation therapy and continue to reduce the number of open-heart surgeries in this population. In this review, we underline the limitations and issues associated with the devices available currently, and we focus on the development of new strategies (such as hybrid approaches or magnetic resonance-guided procedures), new devices (such as right ventricular outflow tract reducers or the novel Native Outflow Tract valved stent from Medtronic) and new technologies (such as tissue-engineered valves), which may help to take up these challenges and represent the future of transcatheter valve implantation.

Aortic root compression during transcatheter pulmonary valve replacement

“…This is definitely a topic that needs to be studied further with an emphasis on predicting ARC from pre‐TPVR cross‐sectional imaging. Finally, ARC will need to be considered as a new generation of self‐expanding valve platforms become available for this indication .…”

Staged Catheter-Based Valve Treatment of Severe Carcinoid Heart Disease

“…The Medtronic Melody® valve and the Edwards SAPIEN valve are in use today for percutaneous pulmonary valve implantation in children and in adults with congenital heart disease. Although long-term results are not available, several studies have shown that both valves are safe and durable up to 5 years [6,7]. …”

Update – Interventionelle Kinderkardiologie

“…30 mm. Gegebenenfalls lässt sich durch ein wiederholtes Prestenting (Stent-in-Stent) eine Verkleinerung erreichen, sodass doch noch eine perkutane Klappe implantiert werden kann [17]. In selektiven Fällen ist auch eine Implantation einer Katheterklappe in eine singuläre Pulmonalarterie möglich oderbei mangelnder Verankerung im Pulmonalisstammauch eine beidseitige Klappenversorgung der Pulmonalarterien [18,19].…”