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Percutaneous pulmonary valve implantation in small conduits: A multicenter experience
Sebastien Hascoet1, José Diogo Martins2, Haysam Baho3
1Hôpital des enfants, Cardiologie pédiatrique, Centre de Compétence Malformations Congénitales Complexes M3C, CHU Toulouse, 31100 Toulouse, France; Hôpital Marie Lannelongue, Pôle de cardiopathies congénitales de l'enfant et de l'adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C- 92350 Le Plessis-Robinson, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, France; Inserm/UPS UMR 1048 - I2MC, CHU Toulouse, Toulouse, France.
Percutaneous pulmonary valve implantation (PPVI) is feasible in small or over-expanded conduits, but carries a high risk of rupture. Careful patient selection and expert technique are crucial for successful outcomes in these challenging cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Current guidelines restrict percutaneous pulmonary valve implantation (PPVI) to conduits larger than 16mm.
- Balloon dilatation of conduits exceeding 110% of their original size is also not recommended.
- This study investigates PPVI in patients who fall outside these guidelines.
Purpose of the Study:
- To evaluate the feasibility and outcomes of PPVI in small or over-expanded conduits.
- To assess the safety and efficacy of PPVI in patients not meeting standard guideline criteria.
Main Methods:
- Retrospective analysis of 14 patients undergoing PPVI in conduits <16mm or >110% diameter.
- Data collected on patient demographics, conduit size, pre- and post-procedure pressures, complications, and follow-up.
- Procedures were performed between May 2008 and July 2016 across 8 institutions.
Main Results:
- Successful PPVI was achieved in all 14 patients.
- Conduit rupture occurred in 50% of cases, managed with covered stents in most instances.
- Post-implantation right ventricular pressure significantly decreased; patients remained asymptomatic at follow-up.
Conclusions:
- PPVI can be technically feasible in small or over-expanded conduits.
- High rates of conduit rupture necessitate careful patient selection and experienced operators.
- Further research is required to fully understand the risks and benefits in this specific patient population.
