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. 2019 Apr;8(2):107-113.
doi: 10.21037/tp.2019.04.02.

Percutaneous pulmonary valve implantation (PPVI) in non-obstructive right ventricular outflow tract: limitations and mid-term outcomes

Anoosh Esmaeili  1 , Markus Khalil  2 , Kachina Behnke-Hall  1 , Maria Belen Gonzalez Y Gonzalez  1   2 , Gunter Kerst  3 , Stephan Fichtlscherer  4 , Hakan Akintuerk  2 , Dietmar Schranz  1   2
Affiliations

Percutaneous pulmonary valve implantation (PPVI) in non-obstructive right ventricular outflow tract: limitations and mid-term outcomes

Anoosh Esmaeili et al. Transl Pediatr. 2019 Apr.

Abstract

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.

Keywords: Native right ventricular outflow tract (native RVOT); mid-term follow-up; percutaneous pulmonary valve implantation; pulmonary regurgitation (PI).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Comparison of QRS duration pre-PPVI, post-PPVI, and at follow-ups. PPVI, percutaneous pulmonary valve implantation; ms, milliseconds.
Figure 2
Figure 2
Ablation catheter in RVOT at the earliest local ventricular activation of PVC. RVOT, right ventricular outflow tract; PVC, premature ventricular contraction.
See this image and copyright information in PMC

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