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Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement

Published online by Cambridge University Press:  27 January 2023

Dana M. Boucek*
Affiliation:
Department of Pediatric Cardiology, University of Utah, Primary Children’s Hospital, Salt Lake City, UT, USA
Athar M. Qureshi
Affiliation:
The Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Varun Aggarwal
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Masonic Children’s Hospital, Minneapolis, MN, USA
Zachary A. Spigel
Affiliation:
Department of Surgery, Allegheny Health Network Medical Education Consortium, Pittsburgh, PA, USA
Joyce Johnson
Affiliation:
Department of Pediatric Cardiology, John’s Hopkins All Children’s Hospital, St. Petersburg, FL, USA
Robert G. Gray
Affiliation:
Department of Pediatric Cardiology, University of Utah, Primary Children’s Hospital, Salt Lake City, UT, USA
Mary Hunt Martin
Affiliation:
Department of Pediatric Cardiology, University of Utah, Primary Children’s Hospital, Salt Lake City, UT, USA
*
Author for correspondence: D. M. Boucek, MD, Department of Pediatric Cardiology, University of Utah, 81 N. Mario Capecchi Drive, Salt Lake City, UT 84113, USA. Tel: 801-213-3599; Fax: 801-213-7778. E-mail: dana.boucek@hsc.utah.edu

Abstract

Objectives:

To determine the safety and feasibility of over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement.

Background:

Transcatheter pulmonary valve placement is an alternative to surgical pulmonary valve replacement. Traditionally, it was thought to be unsafe to expand a conduit to >110% of its original size.

Methods:

This retrospective cohort study from two centers includes patients with right ventricle to pulmonary artery conduits with attempted transcatheter pulmonary valve placement from 2010 to 2017. Demographic, procedural, echocardiographic and follow-up data, and complications were evaluated in control and overdilation (to >110% original conduit size) groups.

Results:

One hundred and seventy-two patients (51 overdilation and 121 control) had attempted transcatheter pulmonary valve placement (98% successful). The overdilation group was younger (11.2 versus 16.7 years, p < 0.001) with smaller conduits (15 versus 22 mm, p < 0.001); however, the final valve size was not significantly different (19.7 versus 20.2 mm, p = 0.2). Baseline peak echocardiographic gradient was no different (51.8 versus 55.6 mmHg, p = 0.3). Procedural complications were more frequent in overdilation (18%) than control (7%) groups (most successfully addressed during the procedure). One patient from each group required urgent surgical intervention, with no procedural mortality. Follow-up echocardiographic peak gradients were similar (24.1 versus 26 mmHg, p = 0.5).

Conclusions:

Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement can be performed successfully. Procedural complications are more frequent with conduit overdilation, but there was no difference in the rate of life-threatening complications. There was no difference in valve function at most recent follow-up, and no difference in rate of reintervention. The long-term outcomes of transcatheter pulmonary valve placement with conduit over-expansion requires further study.

Type
Original Article
Copyright
© The Author(s), 2023. Published by Cambridge University Press

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Footnotes

Work performed at the University of Utah and Primary Children’s Hospital in Salt Lake City, Utah, and at the Texas Children’s Hospital in Houston, Texas.

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