Castaldi Biagio, Butera Gianfranco, Chessa Massimo, Galletti Lorenzo, Giamberti Alessandro, Giugno Luca, Secinaro Aurelio, Vida Vladimiro, Di Salvo Giovanni, Carminati Mario
pediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, Italy.
Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD-Heart, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy.
Int J Cardiol Congenit Heart Dis. 2023 Oct 5;14:100478. doi: 10.1016/j.ijcchd.2023.100478. eCollection 2023 Dec.
Transcatheter Pulmonary Valve Implantation (TPVI), when feasible, is the first-line approach to pulmonary valve replacement. Our aim was to obtain a picture of current TPVI practice in Italy.
After conducting a literature review on TPVI, online surveys were devised by an Advisory Board of 10 experts from the three Italian reference centers for congenital heart diseases and sent electronically to physicians working either in implanting center or in referral non-implanting cardiologic centers.
Approximately 450 physicians across Italy were invited to contribute. 82 (18%) physicians answered. EchoColorDoppler, electrocardiogram and cardiac magnetic resonance were considered the first line approach to monitor these patients, before and after TPVI.For non-implanting centers, reasons for non-referral of patients for PVR were: paucisymptomatic disease (67%) and patients' poor adherence to disease management programs (41%), but also the lack of connections with specialized centers (33%). For implanters, the main reasons for refraining from TPVI were: high risk for coronary compression (67% first rank), the need for concomitant cardiac surgical procedures (39% first rank) and the unsuitable anatomy of the conduit (39% first rank). The availability of new larger valves of a self-expandable nature was indicated as a key technological development for expanding the cohort of patients currently eligible for TPVI.
Despite a non-invasive imaging protocol for the follow up and selection of patients candidate to TPVI is well implemented in Italy, there is still a lack in connections between non-implanting and implanting centers.
经导管肺动脉瓣植入术（TPVI）在可行时是肺动脉瓣置换的一线治疗方法。我们的目的是了解意大利目前TPVI的应用情况。
在对TPVI进行文献综述后，由来自意大利三个先天性心脏病参考中心的10位专家组成的咨询委员会设计了在线调查问卷，并通过电子邮件发送给在植入中心或转诊非植入心脏病中心工作的医生。
约450名意大利医生受邀参与。82名（18%）医生回复。超声心动图、心电图和心脏磁共振被认为是TPVI前后监测这些患者的一线方法。对于非植入中心，不将患者转诊进行肺动脉瓣置换的原因包括：症状轻微的疾病（67%）、患者对疾病管理计划的依从性差（41%），以及与专业中心缺乏联系（也占33%）。对于植入医生而言，不进行TPVI的主要原因包括：冠状动脉受压风险高（67%列为首要原因）、需要同期进行心脏外科手术（39%列为首要原因）以及管道解剖结构不合适（39%列为首要原因）。新型更大尺寸的自膨胀瓣膜的可用性被认为是扩大目前符合TPVI条件患者群体的关键技术发展。
尽管意大利已很好地实施了用于TPVI候选患者随访和选择的非侵入性成像方案，但非植入中心与植入中心之间仍缺乏联系。
