Document Detail


Percutaneous pulmonary valve-in-valve implantation: a successful treatment concept for early device failure.
MedLine Citation:
PMID:  18316357     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Percutaneous pulmonary valve implantation (PPVI) is now an accepted treatment strategy for right ventricular (RV) outflow tract (RVOT) dysfunction in many European Heart Centres. We analysed the efficacy of repeat PPVI as a treatment modality for early device failure. METHODS AND RESULTS: Twenty patients underwent repeat PPVI for RVOT obstruction because of early device failure ('Hammock effect', 'Hammock-like effect', stent fracture, residual stenosis). Repeat PPVI was feasible in all patients with no procedural complications. Following implantation of a second device, catheter-measured RVOT gradient and RV systolic pressure fell significantly (RVOT gradient: 46.1 +/- 3.9 to 18.1 +/- 2.4 mmHg, P < 0.001; RVSP: 70.9 +/- 4.8 to 46.1 +/- 2.6 mmHg, P < 0.001), in all but one patient (15 years, male, common arterial trunk, 11.5 mm homograft). During follow-up, four of 20 required re-intervention [third PPVI for stent fracture (n = 2), device explantation: external compression by the sternum (n = 1), endocarditis (n = 1)], and one of the 20 is awaiting surgical management. In the remainder, second PPVI resulted in a sustained improvement in haemodynamics with a mean follow-up of 10.9 +/- 3.0 months. In this series, the probability of freedom from re-intervention at 2 years was higher after second PPVI when compared with the index procedure (89.4 vs. 20.0%, P < 0.001). CONCLUSION: Repeat PPVI is an effective treatment for early device failure in defined conditions and leads to improved freedom from re-intervention.
Authors:
Johannes Nordmeyer; Louise Coats; Philipp Lurz; Twin-Yen Lee; Graham Derrick; Philipp Rees; Seamus Cullen; Andrew M Taylor; Sachin Khambadkone; Philipp Bonhoeffer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-03-03
Journal Detail:
Title:  European heart journal     Volume:  29     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-17     Completed Date:  2008-11-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  810-5     Citation Subset:  IM    
Affiliation:
Cardiothoracic Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Angioplasty, Transluminal, Percutaneous Coronary / methods
Child
Female
Follow-Up Studies
Heart Defects, Congenital / surgery
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / methods*
Humans
Male
Prosthesis Failure
Pulmonary Valve
Pulmonary Valve Insufficiency / therapy*
Recurrence / prevention & control
Treatment Outcome
Ventricular Outflow Obstruction / therapy*
Grant Support
ID/Acronym/Agency:
rg/03/006//British Heart Foundation

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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