Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, Munich, Germany; Center for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
Center for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
J Cardiol. 2019 Sep;74(3):217-222. doi: 10.1016/j.jjcc.2019.03.021. Epub 2019 Jun 21.
Percutaneous pulmonary valve implantation (PPVI) numbers are rising but are still minor compared to surgery due to several contraindications. We sought to analyze the impact of PPVI compared to standard surgery in an unselected cohort with dysfunctional right ventricular outflow tract (RVOT). Reasons for PPVI failure and possible contraindications were explored.
Between 2010 and 2015 all consecutive patients who underwent surgery or intervention for a dysfunctional RVOT were investigated.
A total of 382 cases was identified - 246 patients underwent successful valve insertion: 166 surgeries (166/246=67.4%) with 55/166 homografts (33.1%), 106 Contegra grafts (63.8%), 5 Hancock valves (3.0%). Overall, 70/246 patients presented a priori with an enlarged RVOT>28mm (28.5%) not appropriate for PPVI and 14/246 (5.7%) had additional defects necessitating surgery. Some 31/246 patients had surgery for initial repair of congenital defects or were too small (<20kg) for PPVI (12.6%). 80 underwent successful PPVI (32.5% of 246 valves implanted) [51 Edwards Sapien valves (63.7%), 29 Melody valves (36.3%)]. The RVOT was too large for PPVI in 22/246 patients (8.9%). A total 20/246 patients (8.1%) showed coronary compression after balloon interrogation. In 4/246 patients PPVI was not possible due to technical issues (1.4%).
PPVI could be performed successfully in 80/382 patients (20.9%). An enlarged RVOT, small patient size, and coronary compression were the major obstacles for interventional management. Future developments for larger RVOTs and smaller body weight may expand the indication for PPVI.
经皮肺动脉瓣植入术（PPVI）的数量正在增加，但由于存在多种禁忌症，与手术相比仍较少。我们旨在分析在未选择的功能性右心室流出道（RVOT）功能障碍患者中，PPVI 与标准手术相比的影响。探讨了 PPVI 失败的原因和可能的禁忌症。
2010 年至 2015 年间，对所有接受 RVOT 功能障碍手术或介入治疗的连续患者进行了调查。
共确定了 382 例病例-246 例患者成功进行了瓣膜植入：166 例手术（166/246=67.4%），其中 55/166 例同种移植物（33.1%），106 例 Contegra 移植物（63.8%），5 例 Hancock 瓣膜（3.0%）。总体而言，70/246 例患者的 RVOT 术前大于 28mm（28.5%），不适合进行 PPVI，14/246（5.7%）有额外的缺陷需要手术。约 31/246 例患者因先天性缺陷初次修复或太小（<20kg）而不能进行 PPVI（12.6%）。80 例成功进行了 PPVI（植入的 246 个瓣膜中的 32.5%）[51 例 Edwards Sapien 瓣膜（63.7%），29 例 Melody 瓣膜（36.3%）]。22/246 例患者（8.9%）的 RVOT 过大，不适合进行 PPVI。20/246 例患者（8.1%）在球囊探查后出现冠状动脉压迫。4/246 例患者由于技术问题无法进行 PPVI（1.4%）。
在 80/382 例患者（20.9%）中成功进行了 PPVI。扩大的 RVOT、患者体型小和冠状动脉压迫是介入治疗的主要障碍。未来对于更大 RVOT 和更小体重的发展可能会扩大 PPVI 的适应证。
