B-2 | Outcomes of percutaneous pulmonary valve implantation: Cleveland Clinic Experience

Percutaneous pulmonary valve implantation (PPVI) has become a standard procedure for patients with right ventricular to pulmonary artery (RV to PA) conduit dysfunction as well as native pulmonary valve regurgitation. The aim of this study is to review our institutional experience and mid to long-term outcomes since starting the PPVI program in 2010. Our Cardiac Catheterization Database was retrospectively reviewed. All patients who underwent PPVI from 6/1/2010 to 12/31/2017 were included. Patients' demographics, diagnoses and symptoms were recorded. Cardiac catheterization procedure and complications were reviewed. Mid to long term outcomes including reintervention and endocarditis rates were explored. One hundred and four patients underwent PPVI during the study period with a median age of 30 years (8 – 79 yrs), 57.7% were male. Median follow-up was 4 years (1 mo – 12 yrs). The most common diagnosis was Tetralogy of Fallot (46.2%). Ninety-seven patients (93.2%) received the Melody Valve. The procedure was performed in either RV to PA conduit or bioprosthetic valve in 72 (69.2%) and native right ventricular outflow tract in 32 (30.8%). Procedure complication occurred in 11 patients (10.5%); mostly arrhythmia (5/11) which majority did not require any treatment. One mortality occurred in patient with radiation induced severe pulmonary artery calcification and stenosis with rupture of the porcelain native pulmonary artery. During the follow-up period, 4 patients (3.8%) required balloon dilation of the valve at median of 5 years (11 mo – 6 yrs). Six patients (5.8%) required a second PPVI at median of 5.5 years (4 – 7 yrs), 4 for obstruction, 1 for regurgitation, and 1 for combined lesions. Ten patients (9.6%) underwent surgical reintervention, 7 for stenosis, 3 had other concomitant cardiac surgery. Six patients (5.8%) developed endocarditis and were successfully treated with long term intravenous antibiotics. Five patients (4.8%) had non-PPVI related death, 1 had severe heart failure with multiorgan dysfunction. PPVI is associated with low re-intervention rates in mid to long term follow-up. Similar to other studies, 5% of our patients had endocarditis which responded to medical management.