Abstract
Background
Self-expanding pulmonary valve grafts have been designed for percutaneous pulmonary
valve implantation (PPVI) in patients with native repaired right ventricular (RV)
outflow tracts (RVOTs). However, their efficacy, in terms of RV function, and graft
remodeling remain unclear.
Methods
Patients with native RVOTs who received Venus P-valve (N=15) or Pulsta valve (N=38)
implants between 2017 and 2022 were enrolled. We collected data on patient characteristics
and cardiac catheterization parameters as well as imaging and laboratory data before,
immediately after, and 6–12 months after PPVI and identified risk factors for RV dysfunction.
Results
Valve implantation was successful in 98.1% of patients. The median duration of follow-up
was 27.5 months. In the first 6 months after PPVI, all patients exhibited a resolution
of paradoxical septal motion and a significant reduction (P < 0.05) in RV volume,
N-terminal pro-B-type natriuretic peptide levels, and valve eccentricity indices (−3.9%).
Normalization of the RV ejection fraction (≥ 50%) was detected in only 9 patients
(17.3%) and was independently associated with the RV end-diastolic volume index prior
to PPVI (P = 0.03). Nine patients had residual or recurrent pulmonary regurgitation
or paravalvular leak (graded as ≧mild), which was associated with a larger eccentricity
index (>8%) and subsided by 12 months post-implantation.
Conclusions
We identified the risk factors likely to be associated with RV dysfunction and pulmonary
regurgitation following PPVI in patients with native repaired RVOTs. RV volume-based
patient selection is recommended for PPVI of a self-expanding pulmonary valve, along
with monitoring of graft geometry.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Accepted:
March 12,
2023
Received in revised form:
February 18,
2023
Received:
September 25,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
All authors declare no conflicts of interests
Statement of financial support
This study was partially supported by two grants from the Taiwan Ministry of Science and Technology (MOST 106-2314-B-179-MY3 and MOST 107-2314-B-166-MY3). The Venus P-valve™ implantation section of the study was funded by Venus Medtech (Hangzhou) Inc.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
