This Article Full Text Full Text (PDF) All Versions of this Article: 117/15/1964    most recent CIRCULATIONAHA.107.735779v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lurz, P. Articles by Bonhoeffer, P. Search for Related Content PubMed PubMed Citation Articles by Lurz, P. Articles by Bonhoeffer, P. Related Collections Catheter-based coronary and valvular interventions: other Pediatric and congenital heart disease, including cardiovascular surgery Related Article

(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.

---

 

CLINICAL PERSPECTIVE

Related Article:

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

This article has been cited by other articles:

				T. D. Karamitsos, J. M. Francis, S. Myerson, J. B. Selvanayagam, and S. Neubauer The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure J. Am. Coll. Cardiol., October 6, 2009; 54(15): 1407 - 1424. [Abstract] [Full Text] [PDF]

				P. Lurz, R. Puranik, J. Nordmeyer, V. Muthurangu, M. S. Hansen, S. Schievano, J. Marek, P. Bonhoeffer, and A. M. Taylor Improvement in left ventricular filling properties after relief of right ventricle to pulmonary artery conduit obstruction: contribution of septal motion and interventricular mechanical delay Eur. Heart J., September 2, 2009; 30(18): 2266 - 2274. [Abstract] [Full Text] [PDF]

				E. Ferrari, C. Sulzer, E. Rizzo, and L. K. von Segesser Transcatheter stent-valve implantation in a stenotic pulmonary conduit via a sub-xyphoidian access Eur. J. Cardiothorac. Surg., September 1, 2009; 36(3): 595 - 597. [Abstract] [Full Text] [PDF]

				L. Dos, A. Dadashev, D. Tanous, I. J. Ferreira-Gonzalez, K. Haberer, S. C. Siu, G. S. Van Arsdell, E. N. Oechslin, W. G. Williams, and C. K. Silversides Pulmonary valve replacement in repaired tetralogy of Fallot: Determinants of early postoperative adverse outcomes J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 553 - 559. [Abstract] [Full Text] [PDF]

				J. Nordmeyer, V. Tsang, R. Gaudin, P. Lurz, A. Frigiola, A. Jones, S. Schievano, C. van Doorn, P. Bonhoeffer, and A. M. Taylor Quantitative assessment of homograft function 1 year after insertion into the pulmonary position: impact of in situ homograft geometry on valve competence Eur. Heart J., September 1, 2009; 30(17): 2147 - 2154. [Abstract] [Full Text] [PDF]

				J. Nordmeyer, P. Lurz, V. T. Tsang, L. Coats, F. Walker, A. M. Taylor, S. Khambadkone, M. R. de Leval, and P. Bonhoeffer Effective transcatheter valve implantation after pulmonary homograft failure: A new perspective on the Ross operation J. Thorac. Cardiovasc. Surg., July 1, 2009; 138(1): 84 - 88. [Abstract] [Full Text] [PDF]

				P. Lurz, J. Nordmeyer, V. Muthurangu, S. Khambadkone, G. Derrick, R. Yates, M. Sury, P. Bonhoeffer, and A. M. Taylor Comparison of Bare Metal Stenting and Percutaneous Pulmonary Valve Implantation for Treatment of Right Ventricular Outflow Tract Obstruction: Use of an X-Ray/Magnetic Resonance Hybrid Laboratory for Acute Physiological Assessment Circulation, June 16, 2009; 119(23): 2995 - 3001. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 2, 2009; 53(22): 2080 - 2097. [Full Text] [PDF]

				G.-J. Zong, Y. Bai, H.-B. Jiang, W.-P. Li, H. Wu, X.-X. Zhao, and Y.-W. Qin Use of a novel valve stent for transcatheter pulmonary valve replacement: An animal study. J. Thorac. Cardiovasc. Surg., June 1, 2009; 137(6): 1363 - 1369. [Abstract] [Full Text] [PDF]

				C. J. Bruce and H. M. Connolly Right-Sided Valve Disease Deserves a Little More Respect Circulation, May 26, 2009; 119(20): 2726 - 2734. [Full Text] [PDF]

				N. Piazza, A. Asgar, R. Ibrahim, and R. Bonan Transcatheter Mitral and Pulmonary Valve Therapy J. Am. Coll. Cardiol., May 19, 2009; 53(20): 1837 - 1851. [Abstract] [Full Text] [PDF]

				P Lurz, J Nordmeyer, L Coats, A M Taylor, P Bonhoeffer, and I Schulze-Neick Immediate clinical and haemodynamic benefits of restoration of pulmonary valvar competence in patients with pulmonary hypertension Heart, April 1, 2009; 95(8): 646 - 650. [Abstract] [Full Text] [PDF]

				J. E. Deanfield, R. Yates, F. J. Meijboom, and B. J.M. Mulder CHAPTER 10 Congenital Heart Disease in Children and Adults ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				M. Mack Fool me once, shame on you; fool me twice, shame on me! A perspective on the emerging world of percutaneous heart valve therapy. J. Thorac. Cardiovasc. Surg., October 1, 2008; 136(4): 816 - 819. [Full Text] [PDF]