Key result
Hybrid annuloplasty ring placement enables successful transcatheter valve implantation in ~60% of Bjork Fontan patients.
Why the study?
Prosthetic tricuspid valve placement in Bjork Fontan patients born with tricuspid atresia can transition them to biventricular circulation, but intermediate-term results of a hybrid annuloplasty ring and transcatheter valve approach needed evaluation.
Does hybrid prosthetic valve placement using an annuloplasty ring followed by transcatheter valve implant improve outcomes in Bjork Fontan patients with large connections?
Observational (n=5)
No
Does hybrid prosthetic valve placement using an annuloplasty ring followed by transcatheter valve implant improve outcomes in Bjork Fontan patients with large connections?
A hybrid approach using an incomplete annuloplasty ring to enable transcatheter valve placement is feasible for Bjork Fontan patients with connections too large for standard valves, leading to improved NYHA class and hemodynamics.
Answers are grounded in this paper and cite their sources.
Hybrid approach feasible with NYHA improvement in small series; leaves open safety and durability questions for prospective evaluation.
BACKGROUND Prosthetic ‘tricuspid valve’ placement in Bjork Fontan patients born with tricuspid atresia can transition these patients to a biventricular circulation. OBJECTIVE Describe intermediate term results of hybrid prosthetic valve placement in Bjork Fontans using annuloplasty ring placement around the Bjork connection followed by transcatheter valve. METHODS A retrospective review of hybrid attempts to valve large Bjork Fontans at UCLA. Only Bjorks that had failed balloon sizing for transcatheter valve placement or had prohibitively large dimensions on cross sectional imaging were included. All had attempted surgical placement of a non-circumferential annuloplasty ring around the Bjork Fontan and subsequent Sapien valve implant. RESULTS Median age of the five patients was 40-years. Three had successful placement of annuloplasty rings with a 30 mm (n=2) or a 34 mm Edwards Physio Annuloplasty ring followed by successful valving with 29 Sapien 3 valves. In two patients, attempts to place a surgical ring resulted in bleeding requiring cardiopulmonary bypass and surgical valve placement. The median follow-up time was 28.7 months. All patients had a significant decrease in CVP and were alive with improvement in their NYHA class to I at most recent follow-up. There was no evidence of valve dysfunction seen on follow up ECHO or cross-sectional imaging. CONCLUSION Bjork Fontan patients often have connections to large for available balloon expandable valves. These patients can be treated with a hybrid incomplete annuloplasty ring placement to enable transcatheter valve placement.
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Levi et al. (2026) conducted an observational in Bjork Fontan with tricuspid atresia (n=5). Hybrid incomplete annuloplasty ring placement followed by transcatheter valve placement was evaluated on Successful placement of annuloplasty rings followed by successful transcatheter valving.
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