Key result
Percutaneous pulmonary valve implantation in native or reconstructed RVOT was successful in 96% of patients, with competent valves at 2 years, though 11.5% developed ventricular arrhythmias.
Why the study?
Most patients needing a pulmonary valve have a native, non-obstructive RVOT, where PPVI with balloon-expandable valves requires pre-stenting to create a landing zone and reduce diameter.
What are the medium-term outcomes and limitations of percutaneous pulmonary valve implantation (PPVI) in patients with a native or reconstructed non-obstructive right ventricular outflow tract?
Observational (n=26)
What are the medium-term outcomes and limitations of percutaneous pulmonary valve implantation (PPVI) in patients with a native or reconstructed non-obstructive right ventricular outflow tract?
PPVI in native or reconstructed non-obstructive RVOT shows excellent medium-term mechanical valve function, but advanced RVOT manipulations may be associated with significant ventricular arrhythmias.
Supports feasibility of off-label PPVI in native RVOT with competent valves at 2 years; leaves open arrhythmia risks and need for dedicated reduction devices.
BACKGROUND: Percutaneous pulmonary valve implantation (PPVI) has been established as a safe and effective alternative to surgery treating patients with a failing pulmonary valve conduit. Nevertheless, the majority of patients in need of a valve have a native, non-obstructive right ventricular outflow tract (RVOT). The current approved stent-valves have a balloon-expandable design. Pre-stenting of the RVOT to create a landing zone and also protect the valve stability is usually mandatory; large, non-obstructive RVOTs need pre-stenting to reduce the RVOT-diameter for a balloon-expandable valve implantation. METHODS: A retrospective study design was used to analyze the medium-term outcome after PPVI in a series of 26 patients with native or reconstructed RVOT. RESULTS: PPVI was successfully performed in all, but 1 (96%). Within the follow-up of a minimum of 2 years, the percutaneous implanted valves remained competent; a significant pressure gradient was not detected. Furthermore, no PPVI-related complications such as endocarditis, migration or stent fractures were observed. The electrocardiogram at rest, in particular the QRS duration remained unchanged immediate post-PPVI as well as at medium-term follow-up of 24 months. However, ventricular arrhythmias were documented in 3 patients (11.5%); all patients were successfully treated with antiarrhythmic drugs, utilizing metoprolol. A trial of an invasive catheter based RVOT-ablation in one remained unsuccessful; pre-stented RVOT did not allow a successful intervention. CONCLUSIONS: Medium-term follow-up showed excellent results of the mechanical valve function. PPVI utilizing balloon-expandable stent-valves in a native RVOT remains an off-label use. Despite our encouraging results, advanced manipulations of the patched or native RVOT might be associated with significant ventricular arrhythmias. There is a need for less invasive RVOT reduction devices.
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Esmaeili et al. (2019) conducted an observational in Native or reconstructed right ventricular outflow tract (RVOT) (n=26). Percutaneous pulmonary valve implantation (PPVI) was evaluated on Procedural success. Percutaneous pulmonary valve implantation in native or reconstructed RVOT was successful in 96% of patients, with competent valves at 2 years, though 11.5% developed ventricular arrhythmias.
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