Author + information
- Received October 19, 2017
- Revision received January 15, 2018
- Accepted January 23, 2018
- Published online March 19, 2018.
- Athar M. Qureshi, MDa,b,c,∗ (, )
- Neha Bansal, MDd,
- Doff B. McElhinney, MDe,
- Younes Boudjemline, MDf,
- Tom J. Forbes, MDd,
- Nicola Maschietto, MDg,
- Shabana Shahanavaz, MDh,
- John P. Cheatham, MDi,
- Richard Krasuski, MDc,j,
- Luke Lamers, MDk,
- Massimo Chessa, MDl,
- Brian H. Morray, MDm,
- Bryan H. Goldstein, MDn,
- Cory V. Noel, MDa,
- Yunfei Wang, PhDa and
- Matthew J. Gillespie, MDo
- aThe Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
- bCenter of Pediatric and Congenital Heart Disease, Cleveland Clinic Children’s and Pediatric Institute, The Cleveland Clinic, Cleveland, Ohio
- cDepartment of Cardiovascular Medicine, Heart and Vascular Institute, The Cleveland Clinic, Cleveland, Ohio
- dDivision of Pediatric Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
- eDepartments of Pediatrics and Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center, Stanford University School of Medicine, Palo Alto, California
- fDepartment of Paediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes–M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Paris, France
- gPediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, Padova, Italy
- hDivision of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri
- iCenter, Nationwide Children's Hospital, Columbus, Ohio
- jDivision of Cardiology, Duke University Medical Center, Durham, North Carolina
- kAmerican Family Children’s Hospital, Madison, Wisconsin
- lPediatric and Adult Congenital Heart Center, IRCCS-Policlinico San Donato–University Hospital, Milan, Italy
- mDivision of Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington
- nThe Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine; Cincinnati, Ohio
- oThe Cardiac Center at the Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Athar M. Qureshi, CE Mullins Cardiac Catheterization Laboratories, The Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, 6621 Fannin Street, MC 19345C, Houston, Texas 77030.
Objectives The authors sought to assess the intermediate-term effects of percutaneous placed valves in the branch pulmonary artery (PA) position.
Background Most patients with large right ventricular outflow tracts (RVOTs) are excluded from available percutaneous pulmonary valve options. In some of these patients, percutaneous branch PA valve implantation may be feasible. The longer-term effects of valves in the branch PA position is unknown.
Methods Retrospective data were collected on patients with significant pulmonary regurgitation who had a percutaneous branch PA valve attempted.
Results Percutaneous branch PA valve implantation was attempted in 34 patients (18 bilateral and 16 unilateral). One-half of the patients were in New York Heart Association (NHYA) functional class III or IV pre-implantation. There were 2 failed attempts and 6 procedural complications. At follow-up, only 1 patient had more than mild valvar regurgitation. The right ventricular end-diastolic volume index decreased from 147 (range: 103 to 478) ml/m2 to 101 (range: 76 to 429) ml/m2, p < 0.01 (n = 16), and the right ventricular end-systolic volume index decreased from 88.5 (range: 41 to 387) ml/m2 to 55.5 (range: 40.2 to 347) ml/m2, p < 0.01 (n = 13). There were 5 late deaths. At a median follow-up of 2 years, all other patients were in NYHA functional class I or II.
Conclusions Percutaneous branch PA valve implantation results in a reduction in right ventricular volume with clinical benefit in the intermediate term. Until percutaneous valve technology for large RVOTs is refined and more widely available, branch PA valve implantation remains an option for select patients.
Drs. McElhinney, Boudjemline, Cheatham, Morray, and Gillespie, have been proctors/consultants for Medtronic. Dr. Forbes has been a proctor for Edwards Lifesciences. Dr. Krasuski has been an investigator for clinical trials for Edwards Lifesciences and Abbott Medical; and has been a consultant for and received research funding from Acetelion. Dr. Goldstein has served as a consultant for Medtronic and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 19, 2017.
- Revision received January 15, 2018.
- Accepted January 23, 2018.
- 2018 American College of Cardiology Foundation