Document Detail


Pre-stenting with a bare metal stent before percutaneous pulmonary valve implantation: acute and 1-year outcomes.
MedLine Citation:
PMID:  20965979     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
OBJECTIVES: To determine the feasibility and safety of pre-stenting with a bare metal stent (BMS) before percutaneous pulmonary valve implantation (PPVI), and to analyse whether this approach improves haemodynamic outcomes and impacts on the incidence of PPVI stent fractures.
DESIGN: Retrospective analysis of prospectively collected data.
SETTING: Tertiary paediatric and adult congenital heart cardiac centre.
PATIENTS AND INTERVENTIONS: 108 consecutive patients with congenital heart disease underwent PPVI between September 2005 and June 2008 (54 with PPVI alone, 54 with BMS pre-stenting before PPVI).
RESULTS: There were no significant differences in procedural complication rates. Acutely, there was no difference in haemodynamic outcomes. Serial echocardiography revealed that in the subgroups of 'moderate' (26-40 mm Hg) and 'severe' (>40 mm Hg) right ventricular outflow tract (RVOT) obstruction, patients with pre-stenting showed a tendency towards lower peak RVOT velocities compared to patients after PPVI alone (p=0.01 and p=0.045, respectively). The incidence of PPVI stent fractures was not statistically different between treatment groups at 1 year (PPVI 31% vs BMS+PPVI 18%; p=0.16). However, pre-stenting with BMS was associated with a lower risk of developing PPVI stent fractures (HR 0.35, 95% CI 0.14 to 0.87, p=0.024). The probability of freedom from serious adverse follow-up events (death, device explantation, repeat PPVI) was not statistically different at 1 year (PPVI 92% vs BMS+PPVI 94%; p=0.44).
CONCLUSIONS: Pre-stenting with BMS before PPVI is a feasible and safe modification of the established implantation protocol. Pre-stenting is associated with a reduced risk of developing PPVI stent fractures.
Authors:
Johannes Nordmeyer; Philipp Lurz; Sachin Khambadkone; Silvia Schievano; Alexander Jones; Doff B McElhinney; Andrew M Taylor; Philipp Bonhoeffer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-10-21
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  97     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  118-23     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Unit, UCL Institute of Child Health, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Grant Support
ID/Acronym/Agency:
CI/05/010//British Heart Foundation

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