Key result
Percutaneous catheter-based valve implantations are gaining acceptance for failing homografts in the pulmonary position, which will likely decrease the demand for conventional surgery.
Percutaneous and transventricular minimally invasive options are gaining acceptance for treating failing pulmonary homografts, potentially decreasing the need for conventional surgery.
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May support fewer reoperations for failing pulmonary homografts; hypothesis-generating and requires prospective trials before practice change.
Homograft implantation in the pulmonary position is usually part of initial repair in congenital heart defects with dysplasia or atresia of the pulmonary valve and at the time of the Ross operation. As part of reoperations, homografts are mainly required after nonvalved right ventricular outflow tract procedures. Due to an annual increase of homograft dysfunction, replacement is inevitable. Recently, percutaneous catheter-based valve implantations gain increasing acceptance. Even transventricular pulmonary valve implantation has been reported. Prior to decision making for any surgical or interventional therapy, the right ventricular outflow tract morphology together with additional pathologies need to be assessed. With the development of new prostheses and delivery modes, the demand for conventional surgery will further decrease.
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Schreiber et al. (2010) conducted a review in Failing homografts in the pulmonary position. Percutaneous catheter-based valve implantations vs. Conventional surgery was evaluated. Percutaneous catheter-based valve implantations are gaining acceptance for failing homografts in the pulmonary position, which will likely decrease the demand for conventional surgery.
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