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Transcatheter Interventions for Atrioventricular Dysfunction in Patients with Adult Congenital Heart Disease: An
Nili Schamroth Pravda1,2, Hana Vaknin Assa1,2, Lars Sondergaard3
1Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel.
Insights
Transcatheter interventions for atrioventricular (AV) valve dysfunction in adult congenital heart disease (ACHD) patients are safe and feasible. These procedures offer a viable treatment option for carefully selected ACHD patients with high surgical risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Adult Congenital Heart Disease
Background:
- Adult congenital heart disease (ACHD) patients frequently experience worsening valvular dysfunction.
- Transcatheter valve interventions present an alternative to surgery for high-risk patients.
- Limited data exists on transcatheter interventions for atrioventricular (AV) valve dysfunction in ACHD.
Purpose of the Study:
- To evaluate the feasibility and safety of transcatheter AV valve interventions in ACHD patients.
- To assess outcomes of transcatheter AV valve interventions in a multi-center ACHD registry.
Main Methods:
- International collaborative multi-center registry of ACHD patients undergoing transcatheter AV valve interventions (2016-2022).
- Inclusion of demographic, clinical, and procedural data.
- Focus on both subpulmonary and systemic AV valve interventions.
Main Results:
- Nine ACHD patients underwent AV valve interventions (median age 48 years).
- Primary pathology was regurgitation (78%); procedures included valve-in-valve (5) and edge-to-edge repair (4).
- No major peri-procedural complications or mortality; one-year follow-up showed improved NYHA functional class in most patients.
Conclusions:
- Transcatheter AV valve interventions are feasible and safe in carefully selected ACHD patients.
- These interventions offer an effective treatment option for high-risk ACHD patients.
- Further research is warranted to expand treatment options for ACHD valvular dysfunction.
Introduction:
A substantial proportion of patients with adult congenital heart disease (ACHD) suffer from worsening valvular dysfunction in adulthood. Transcatheter valve interventions can offer a therapeutic alternative to surgery for those at high surgical risk. There is emerging but limited data on transcatheter interventions for atrioventricular (AV) valve dysfunction in patients with ACHD.
Methods:
We compiled an international collaborative multi-center registry focusing on adult patients with congenital heart disease undergoing transcatheter AV valve interventions (repair or replacement). Included were patients from three international centers who underwent procedures between 2016 and 2022. Demographic, clinical, and procedural data were compiled.
Results:
Nine patients with ACHD underwent AV valve interventions. The median age was 48 years (IQR (37; 56), 55% women). At baseline, seven patients (78%) were in NYHA functional class III and two (22%) were in NYHA functional class II. The diagnosis of ACHD varied. Three valve interventions were performed on the subpulmonary AV valve and six on the systemic AV valve. The primary valvular pathology was regurgitation (six patients, 78%). Five procedures were valve-in-valve interventions, and four procedures were transcatheter edge-to-edge repair procedures. There were no major complications or peri-procedural complications or peri-procedural mortality. One patient developed a suspected non-obstructive thrombus on the valve that was medically treated. One patient did not improve clinically following the procedure and underwent a heart transplant, one patient died 6 months following the procedure due to a cardiovascular implantable electronic device infection. At one year, six patients were in NYHA functional class I, and one patient was in NYHA functional class III. In conclusion, transcatheter AV heart valve interventions are feasible and safe procedures in carefully selected ACHD patients. These procedures can offer an effective treatment option in these younger patients with high surgical risk.
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