Branch Pulmonary Artery Valve Implantation Reduces Pulmonary Regurgitation and Improves Right Ventricular Size/Function in Patients With Large Right Ventricular Outflow Tracts

Athar M. Qureshi, Neha Bansal, Doff B. McElhinney, Younes Boudjemline, Tom J. Forbes, Nicola Maschietto, Shabana Shahanavaz, John P. Cheatham, Richard Krasuski, Luke Lamers, Massimo Chessa, Brian H. Morray, Bryan H. Goldstein, Cory V. Noel, Yunfei Wang, Matthew J. Gillespie

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2 Scopus citations

Abstract

Objectives: The authors sought to assess the intermediate-term effects of percutaneous placed valves in the branch pulmonary artery (PA) position. Background: Most patients with large right ventricular outflow tracts (RVOTs) are excluded from available percutaneous pulmonary valve options. In some of these patients, percutaneous branch PA valve implantation may be feasible. The longer-term effects of valves in the branch PA position is unknown. Methods: Retrospective data were collected on patients with significant pulmonary regurgitation who had a percutaneous branch PA valve attempted. Results: Percutaneous branch PA valve implantation was attempted in 34 patients (18 bilateral and 16 unilateral). One-half of the patients were in New York Heart Association (NHYA) functional class III or IV pre-implantation. There were 2 failed attempts and 6 procedural complications. At follow-up, only 1 patient had more than mild valvar regurgitation. The right ventricular end-diastolic volume index decreased from 147 (range: 103 to 478) ml/m 2 to 101 (range: 76 to 429) ml/m 2 , p < 0.01 (n = 16), and the right ventricular end-systolic volume index decreased from 88.5 (range: 41 to 387) ml/m 2 to 55.5 (range: 40.2 to 347) ml/m 2 , p < 0.01 (n = 13). There were 5 late deaths. At a median follow-up of 2 years, all other patients were in NYHA functional class I or II. Conclusions: Percutaneous branch PA valve implantation results in a reduction in right ventricular volume with clinical benefit in the intermediate term. Until percutaneous valve technology for large RVOTs is refined and more widely available, branch PA valve implantation remains an option for select patients.

Original languageEnglish (US)
Pages (from-to)541-550
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume11
Issue number6
DOIs
StatePublished - Mar 26 2018

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Keywords

  • branch pulmonary artery
  • congenital heart disease
  • percutaneous
  • tetralogy of Fallot
  • valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Qureshi, A. M., Bansal, N., McElhinney, D. B., Boudjemline, Y., Forbes, T. J., Maschietto, N., Shahanavaz, S., Cheatham, J. P., Krasuski, R., Lamers, L., Chessa, M., Morray, B. H., Goldstein, B. H., Noel, C. V., Wang, Y., & Gillespie, M. J. (2018). Branch Pulmonary Artery Valve Implantation Reduces Pulmonary Regurgitation and Improves Right Ventricular Size/Function in Patients With Large Right Ventricular Outflow Tracts. JACC: Cardiovascular Interventions, 11(6), 541-550. https://doi.org/10.1016/j.jcin.2018.01.278