Transcatheter pulmonary valve implantation: Initial experience with self-expandable valve in patients with congenital heart diseases and comparison with balloon-expandable valve - 20/09/24
Résumé |
Introduction/Background |
Self-expandable valves have emerged as an alternative option for transcatheter pulmonary valve replacement (TPVR) compared to balloon-expandable valves. However, their efficacy in patients with congenital heart diseases remains relatively unexplored.
Objective |
This study aims to compare the characteristics and outcomes of patients who underwent TPVR with self-expandable valves versus balloon-expandable valves.
Methods |
A prospective single-center analysis was conducted, encompassing all consecutive patients (n=89) who underwent TPVR using either balloon-expandable valves (Sapien 3 valves, n=63, 70%) or self-expandable valves (Venus-P, n=26, 30%) between January 2022 and February 2024. Patient characteristics, procedural data, and short-term outcomes were compared. Electrophysiological studies were performed in all patients with tetralogy of Fallot (ToF) prior to the procedure.
Results |
The median age of patients was 34years for Sapien 3 (11 children, youngest: 8years) and 46years for Venus-P (one child aged 15years), P=0.014. Tetralogy of Fallot (ToF) was the primary diagnosis in 49 cases (55%, 32 with Sapien 3 and 17 with Venus-P valve, P=0.041). Native or patched right ventricular outflow tracts were identified in 100% and 54% of patients with Venus-P and Sapien 3 valves, respectively, P<0.001.
Valve implantation was successful in all patients. Major adverse events occurred in 4.5% of cases (3.8% in Sapien 3 vs. 4.7% in Venus P-valve group, P=0.66). Ventricular ectopy necessitating medical therapy was more frequent in the Venus-P group (19% vs. 0%, P=0.002) including one case of sustained asymptomatic ventricular tachycardia, managed with amiodarone therapy. No peri-procedural deaths were reported.
Conclusion |
Self-expandable valves demonstrate efficacy for TPVR in patients with large native or patched right ventricular outflow tracts, accompanied by a low rate of major adverse events. However, an increased incidence of ventricular arrhythmias was noted compared to balloon-expandable valves, indicating the importance of long-term follow-up data to better understand outcomes.
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Vol 117 - N° 8-9S
P. S231 - août 2024 Retour au numéro
Article précédent
- PEACE-HYPNO – Management of procedural pain by multimodal sedation analgesia combining hypnosis in children with congenital heart disease: A randomized trial of non-inferiority
- M. Gerard, E. Chambon
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- A. Callegari, M. Albertini, L. Iserin, D. Bonnet, S. Malekzadeh-Milani
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