Related Experiment Video
Updated: Jul 7, 2026
Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
Published on: June 8, 2022
Percutaneous pulmonary valve-in-valve implantation: a successful treatment concept for early device failure
Johannes Nordmeyer1, Louise Coats, Philipp Lurz
1Cardiothoracic Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
Aims:
Percutaneous pulmonary valve implantation (PPVI) is now an accepted treatment strategy for right ventricular (RV) outflow tract (RVOT) dysfunction in many European Heart Centres. We analysed the efficacy of repeat PPVI as a treatment modality for early device failure.
Methods And Results:
Twenty patients underwent repeat PPVI for RVOT obstruction because of early device failure ('Hammock effect', 'Hammock-like effect', stent fracture, residual stenosis). Repeat PPVI was feasible in all patients with no procedural complications. Following implantation of a second device, catheter-measured RVOT gradient and RV systolic pressure fell significantly (RVOT gradient: 46.1 +/- 3.9 to 18.1 +/- 2.4 mmHg, P < 0.001; RVSP: 70.9 +/- 4.8 to 46.1 +/- 2.6 mmHg, P < 0.001), in all but one patient (15 years, male, common arterial trunk, 11.5 mm homograft). During follow-up, four of 20 required re-intervention [third PPVI for stent fracture (n = 2), device explantation: external compression by the sternum (n = 1), endocarditis (n = 1)], and one of the 20 is awaiting surgical management. In the remainder, second PPVI resulted in a sustained improvement in haemodynamics with a mean follow-up of 10.9 +/- 3.0 months. In this series, the probability of freedom from re-intervention at 2 years was higher after second PPVI when compared with the index procedure (89.4 vs. 20.0%, P < 0.001).
Conclusion:
Repeat PPVI is an effective treatment for early device failure in defined conditions and leads to improved freedom from re-intervention.
