Percutaneous pulmonary valve implantation preceded by routine prestenting with a bare metal stent
- 15 February 2011
- journal article
- editorial material
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 77 (3), 381-389
- https://doi.org/10.1002/ccd.22700
Abstract
Objectives: To evaluate the effectiveness and safety of percutaneous pulmonary valve implantation (PPVI) with routine prestenting with a bare metal stent (BMS). Background: PPVI is a relatively new method of treating patients with repaired congenital heart disease (CHD). Results of PPVI performed with routine prestenting have never been reported. Methods: Consecutive patients who underwent PPVI for homograft dysfunction with prestenting with BMS were studied. The schedule of follow-up assessment comprised clinical evaluation, cardiovascular magnetic resonance, transthoracic echocardiography, and chest X-ray to screen for device integrity. Results: PPVI was performed with no serious complications in all patients (n = 10, mean age 26.8 ± 4.0 years, 60% males). In nine patients with significant pulmonary stenosis, peak right ventricular outflow tract (RVOT) gradient was reduced from a mean of 80.6 ± 22.7 to 38.8 ± 10.4 mm Hg on the day following implantation (P = 0.001). At 1-month and 6-month follow-ups, mean RVOT gradient was 34.0 ± 9.8 and 32.0 ± 12.2 mm Hg, respectively. In patients with significant pulmonary regurgitation, mean pulmonary regurgitation fraction decreased from 19% ± 6% to 2% ± 1% (P = 0.0008). Relief of RVOT obstruction and restoration of pulmonary valve competence were associated with significant decrease in right ventricular (RV) end-diastolic and end-systolic volumes (125.5 ± 48.6 to 109.2 ± 42.9 mL/m2; P = 0.002 and 68.4 ± 41.5 vs. 50.9 ± 40.6 mL/m2; P = 0.001) as well as improvement in RV ejection fraction (48.8% ± 13.1% to 57.6% ± 14.4%; P = 0.003) and New York Heart Association class (P = 0.003). All patients completed 6-month follow-up. No stent fractures were observed. Conclusions: PPVI with routine prestenting with BMS is a safe and effective method of treatment in patients with repaired CHD.Keywords
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