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(Circulation. 2008;117:1964-1972.)
© 2008 American Heart Association, Inc.

Interventional Cardiology

Percutaneous Pulmonary Valve Implantation

Impact of Evolving Technology and Learning Curve on Clinical Outcome

Philipp Lurz, BSc; Louise Coats, MRCP; Sachin Khambadkone, MD, MRCP; Johannes Nordmeyer, MD; Younes Boudjemline, MD; Silvia Schievano, MEng; Vivek Muthurangu, MRCP; Twin Yen Lee, RN; Giovanni Parenzan, MA; Graham Derrick, MRCP; Seamus Cullen, MRCPI; Fiona Walker, MRCP; Victor Tsang, MD, FRCS; John Deanfield, FRCP; Andrew M. Taylor, MD, MRCP, FRCR; Philipp Bonhoeffer, MD

From the UCL Institute of Child Health (P.L., L.C., S.K., J.N., S.S., V.M., G.D., S.C., V.T., J.D., A.M.T., P.B.), London, United Kingdom; Great Ormond Street Hospital for Children NHS Trust (P.L., L.C., S.K., J.N., S.S., V.M., T.Y.L., G.P., G.D., V.T., J.D., A.M.T., P.B.), Cardiothoracic Unit, London, United Kingdom; Service de Cardiologie Pédiatrique (Y.B.), Hôspital Necker Enfants Malades, Paris, France; and The Heart Hospital NHS Trust (S.C., F.W., V.T., J.D., P.B.), London, United Kingdom.

Correspondence to Philipp Bonhoeffer, Cardiac Unit, Great Ormond Street Hospital, Great Ormond St, London WC1N 3JH, United Kingdom. E-mail BonhoP{at}gosh.nhs.uk

Received August 23, 2007; accepted February 15, 2008.

Background— Percutaneous pulmonary valve implantation was introduced in the year 2000 as a nonsurgical treatment for patients with right ventricular outflow tract dysfunction.

Methods and Results— Between September 2000 and February 2007, 155 patients with stenosis and/or regurgitation underwent percutaneous pulmonary valve implantation. This led to significant reduction in right ventricular systolic pressure (from 63±18 to 45±13 mm Hg, P<0.001) and right ventricular outflow tract gradient (from 37±20 to 17±10 mm Hg, P<0.001). Follow-up ranged from 0 to 83.7 months (median 28.4 months). Freedom from reoperation was 93% (±2%), 86% (±3%), 84% (±4%), and 70% (±13%) at 10, 30, 50, and 70 months, respectively. Freedom from transcatheter reintervention was 95% (±2%), 87% (±3%), 73% (±6%), and 73% (±6%) at 10, 30, 50, and 70 months, respectively. Survival at 83 months was 96.9%. On time-dependent analysis, the first series of 50 patients (log-rank test P<0.001) and patients with a residual gradient >25 mm Hg (log-rank test P=0.01) were associated with a higher risk of reoperations.

Conclusions— Percutaneous pulmonary valve implantation resulted in the ability to avoid surgical right ventricular outflow tract revision in the majority of cases. This procedure might reduce the number of operations needed over the total lifetime of patients with right ventricle–to–pulmonary artery conduits.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2008 117: 1909. [Full Text]