Author + information
- Mary Hunt Martina,b,
- Jeffery Meadowsa,b,
- Bryan Goldsteina,b,
- Lisa Bergersena,b,
- Athar Qureshia,b,
- Shabana Shahanavaza,b,
- Jamil Aboulhosna,b,
- Darren Bermana,b,
- Lynn Penga,b,
- Matthew Gillespiea,b,
- Aimee Armstronga,b,
- Cindy Wenga,b and
- Robert Graya,b
Background: Melody Transcatheter Pulmonary Valve Replacement (TPVR) is FDA approved within right ventricular to pulmonary artery (RV-PA) conduits; however, >80% of patients needing pulmonary valve replacement do not have a conduit. Therefore, Melody TPVR has been adopted clinically to treat native (non-conduit) right ventricular outflow tracts (nRVOT). Safety, feasibility and factors associated with successful nRVOT TPVR have not been studied.
Methods: This is a multicenter, retrospective review of all patients presenting for nRVOT TPVR. Pre-procedural imaging (MRI and echo) and cath data were collected.
Results: Of 229 patients (mean age 21 years, range 4-67) from 11 centers, 132 (58%) had successful TPVR. The remaining 97 (42%) did not receive TPVR due to large nRVOT (n=67), aortic root or coronary compression (n=18) and not clinically indicated (n=12). There were no deaths and 5 (2%) serious complications: stent embolization requiring surgery (4) and arrhythmia requiring cardioversion (1).
Factors associated with successful TPVR included higher TPVR volume center, pre-cath pulmonary stenosis, and no prior transannular patch. Pre-cath MRI measurements were significantly different in the implanted vs. not-implanted groups (Table).
Conclusions: TPVR in the nRVOT is safe, however, nearly half the patients are found not to be candidates, mainly due to large RVOT size. Improved understanding and use of MRI data as well as availability of larger devices may improve success rates for nRVOT TPVR.
Room 146 C
Sunday, March 19, 2017, 9:04 a.m.-9:14 a.m.
Session Title: Highlighted Original Research: Congenital Heart Disease and the Year in Review
Abstract Category: 11. Congenital Heart Disease: Therapy
Presentation Number: 908-12
- 2017 American College of Cardiology Foundation