Abstract 3126: Pulmonary Valve Replacement In Chronic Pulmonary Regurgitation In Adults With Congenital Heart Disease: Influence Of Preoperative QRS-duration On Postoperative Right Ventricular Function

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Mechthild Westhoff-Bleck ◽  
Girke Stefan ◽  
Thomas Breymann ◽  
Joachim Lotz ◽  
Stafanie Pertsch ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement ◽  
Cardiorespiratory Function ◽  
Qrs Duration ◽  
Rv Function

Background: Chronic pulmonary regurgitation (PR) causes progressive right ventricular (RV) dysfunction and heart failure. Parameters defining the optimal time point for surgery of chronic PR are lacking. The present study prospectively evaluated the impact of clinical parameters, cardiorespiratory function and neurohumoral activation on post operative RV function and volumes assessed with magnetic resonance imaging (MRI) after pulmonary valve replacement in patients with severe PR. Methods and Results: MRI was performed preoperatively and at follow-up 5.2±3.5months after surgery in 27 patients (23.6±2.9 years, 15 women) with severe PR. Underlying cardiac disease was repaired Tetralogy of Fallot (n=22), Double outlet right ventricle (n=3) and PR after pulmonary valvulotomy (n=2). Postoperatively, RV endsystolic (RVESVI) and enddiastolic volume indices (RVEDVI) decreased significantly (RVESVI pre 78,2±20,4 ml/m 2 BSA vs. RVESVI post 52,2±16,8 ml/m 2 BSA, p<0,001; RVEDVI pre 150,7±27,7 ml/m 2 BSA vs. RVEDVI post 105,7±26,7 ml/m 2 BSA; p<0,001). Mean RV ejection fraction (RVEF) remained unchanged in the study cohort (47.6 ± 8.7% vs. 49.7 ±7.0%, n.s.). Preoperative volumes did not correlate with postoperative ejection fraction. With increasing preoperative QRS-duration, postoperative RVEF decreased significantly (r=−0.57; p<0,005). A preoperative QRS-duration smaller than the median (156ms) predicted an improved RVEF as compared to a QRS-duration ≤ 156ms (54.9% vs. 46.8%, p<0.05). Neither elevated NT-proBNP levels nor reduced cardiorespiratory function were able to predict postoperative RVEF. Conclusion: Valve replacement in severe pulmonary regurgitation causes significant reduction of RV volumes. Prolonged preoperative QRS-duration was associated with a worse outcome with respect to postoperative RVEF. During follow-up an increase in QRS-duration in patients with chronic PR might indicate deterioration in RV function reflecting a risk of impaired RV function postoperatively.

scholarly journals Mid- to long-term follow-up of pulmonary valve replacement with BioIntegral injectable valve

2020 ◽  
Author(s):  
Simone Ghiselli ◽  
Cristina Carro ◽  
Nicola Uricchio ◽  
Giuseppe Annoni ◽  
Stefano M Marianeschi
Keyword(s):  
Cardiopulmonary Bypass ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement

Abstract OBJECTIVES Chronic pulmonary valve (PV) regurgitation is a common late sequela after repair of congenital heart diseases like tetralogy of Fallot or pulmonary stenosis, leading to right ventricular dilatation and failure and increased late morbidity and mortality. Timely reoperation may lead to a complete right ventricular recovery. An injectable PV allows pulmonary valve replacement, with or without cardiopulmonary bypass, under direct observation, thereby minimizing the impact of surgery on cardiac function. The aim of this study was to evaluate the feasibility and mid- to long-term clinical outcomes with this device. METHODS From April 2007 to October 2019, a total of 85 symptomatic patients with severe pulmonary regurgitation or pulmonary stenosis underwent pulmonary valve replacement with an injectable stented pulmonary prosthesis. Data were collected from the international proctoring registry. Mean patient age was 26.7 years. The underlying diagnosis was repaired tetralogy of Fallot in 69.4% patients; moderate or severe pulmonary regurgitation was present in 72.9%. All patients had echocardiographic scans before the operation and during the follow-up period. A total of 54.1% patients also had preoperative/postoperative cardiac magnetic resonance imaging (MRI) or catheterization; 25.9% had off-pump implants. In 53% patients, pulmonary valve replacement was associated with the repair of other cardiac defects. RESULTS Minor postoperative complications were observed in 10.8% patients. The overall mortality rate was 2.3%; mortality after valve replacement was linked to a severe cardiac insufficiency and it was not related to a prosthesis failure; 1 prosthesis was explanted from 1 patient because of endocarditis, and 6% of patients developed PV stenosis; minor complications occurred in 4.8%. The mean follow-up period was 4.8 years (2 months–12.7 years); 42% of the patients were followed for more than 5 years. Follow-up echocardiography and cardiac MRI showed a significant reduction in RV size and low gradients across the PV. CONCLUSIONS An injectable PV may be implanted without cardiopulmonary bypass and in a hybrid operating theatre with minimal surgical impact. The bioprosthesis, available up to large sizes, has a low profile, laminar flow and no risk of coronary artery compression. Incidence of endocarditis is rare. The lack of a suture ring permits the implant of a relatively larger prosthesis, thereby avoiding a right ventricular outflow tract obstruction. This device permits future percutaneous valve-in-valve procedures, if needed. Results concerning durability are encouraging, and mid- to long-term haemodynamic performance is excellent.

Surgically treated pulmonary stenosis: over 50 years of follow-up

2015 ◽  
Vol 26 (5) ◽  
pp. 860-866 ◽  
Author(s):  
Eva A. Nielsen ◽  
Vibeke E. Hjortdal
Keyword(s):  
Right Ventricular ◽  
Valve Replacement ◽  
Tricuspid Regurgitation ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement ◽  
Ventricular Dilatation ◽  
Right Ventricular Dilatation

AbstractBackgroundSurgical correction was the treatment of choice for pulmonary stenosis until three decades ago, when balloon valvuloplasty was implemented. The natural history of surgically relieved pulmonary stenosis has been considered benign but is actually unknown, as is the need for re-intervention.The objective of this study was to investigate the morbidity and mortality of patients with surgically treated pulmonary stenosis operated at Aarhus University Hospital between 1957 and 2000.ResultsThe total study population included 80 patients. In-hospital mortality was 2/80 (2.5%), and an additional four patients died after hospital discharge; therefore, the long-term mortality was 5%. The maximum follow-up period was 57 years, with a median of 33 years. In all, 16 patients (20%) required at least one re-intervention. Pulmonary valve replacement due to pulmonary regurgitation was the most common re-intervention (67%). Freedom from re-intervention decreased >20 years after the initial repair. In addition, 45% of patients had moderate/severe pulmonary regurgitation, 38% had some degree of right ventricular dilatation, and 40% had some degree of tricuspid regurgitation, which did not require re-intervention at the present stage.ConclusionSurgical relief for pulmonary stenosis is efficient in relieving outflow obstruction; however, this efficiency is achieved at the cost of pulmonary regurgitation, leading to right ventricular dilatation and tricuspid regurgitation. When required, pulmonary valve replacement is performed most frequently >20 years after the initial surgery. Lifelong follow-up of patients treated surgically for pulmonary stenosis is emphasised in this group of patients, who might otherwise consider themselves cured.

Porcine Versus Pericardial Pulmonary Valve Replacement in Adults With Prior Congenital Cardiac Surgery: Midterm Outcomes

2019 ◽  
Vol 10 (2) ◽  
pp. 197-205 ◽  
Author(s):  
Chi Sum Yuen ◽  
Kwok Fai Lucius Lee ◽  
Inderjeet Bhatia ◽  
Nicholson Yam ◽  
Barnabe Antonio Rocha ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement ◽  
Left Ventricular ◽  
Congenital Cardiac Surgery ◽  
Group 2 ◽  
Bioprosthetic Valves ◽  
Group 1

Background: Postcongenital heart surgery pulmonary regurgitation requires subsequent pulmonary valve replacement. We sought to compare the outcomes of pulmonary valve replacement after using bioprosthetic valves, porcine versus pericardial bioprosthesis. Method: Retrospective single-center study of consecutive pulmonary valve replacement in patients with pulmonary regurgitation following initial congenital cardiac surgery. From 2004 to 2016, 82 adult patients (53 males, 29 females) underwent pulmonary valve replacement at a mean age of 28.7 ± 8 years (range 18-52 years) with a mean time to pulmonary valve replacement of 24 ± 7 years (range 13-43 years). Porcine bioprosthetic valves (group 1, n = 32) and pericardial valves (group 2, n = 50) were used. Cardiac magnetic resonance imaging was performed (n = 54) at a mean of 18 ± 13 months before and 24 ± 21 months after pulmonary valve replacement. Results: No significant difference was seen between the groups except that the mean follow-up was longer for group 1 (5.02 ± 2.06 vs 4.08 ± 3.21 years). In-hospital mortality was 1.1%. Follow-up completeness was 100% with no late death. Mean right ventricular end-systolic and end-diastolic volumes reduced significantly in both the groups ( P < .001), whereas right ventricular ejection fraction remained unchanged (group 1, P = .129; group 2, P = .675) . Only the left ventricular end-diastolic volume increased in both the groups, but the increase was significant for group 2 only (group 1, P = .070; group 2, P = .015), whereas the left ventricular end-systolic and ejection fraction remained unchanged in both the groups. There was no reoperation for pulmonary valve replacement. Freedom from intervention was 93.8% (group 1) and 100% (group 2) at eight years after pulmonary valve replacement ( P = .407). Conclusion: Midterm outcomes of pulmonary valve replacement in our adult cohort were satisfactory. Both types of bioprosthetic valves performed comparably for eight years and were a good option in adults.

Abstract 2347: Pulmonary Regurgitation: The Impact on Right Ventricle and the Effect of Percutaneous Pulmonary Valve Replacement

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lars Søndergaard ◽  
Niels G Vejlstrup ◽  
Simone Theilade ◽  
Jens C Nilsson ◽  
Younes Boudjemline ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Volume Overload ◽  
Pulmonary Valve Replacement ◽  
Group A ◽  
The Impact ◽  
Group D ◽  
Percutaneous Pulmonary Valve ◽  
Rv Function

Background Despite successful repair of tetralogy of Fallot (TOF), the life expectancy for these patients remains lower than in the general population. This is mainly due to free pulmonary regurgitation (PR). The importance of maintaining a competent valve has been emphasized, but the optimal timing for intervention remains to be established. The purposes of this study were in a pig model to investigate the consequences of the duration of free PR on RV, and the reversibility of these changes after percutaneous pulmonary valve replacement. Methods Thirtysix farm pigs were divided into four groups (A, B, C and D) of nine pigs. At baseline group A, B and C had a percutaneous stent inserted into the pulmonary annulus to create free PR. After 4, 8 and 12 weeks, respectively, group A, B and C underwent percutaneous valve replacement. In order to allow remodelling of RV, the pigs were observed for four weeks after valve insertion before euthanasia. To examine RV function, MRI was performed before stent insertion, before valve replacement, and before euthanasia. Group D served as controls and underwent five MRI examinations: at baseline as well as after four, eight, twelve and sixteen weeks. Results When comparing the group D with group A, B & C, RVEDV and RVESV were found to gradually increase over time. Furthermore, these volumes normalised after valve replacement in group A and B, but remains increased in the group C. Similar, RVEF was normal after valve replacement in group A and B, but impaired in the group the long-term free PR compared to the controls. Conclusion Better timing of valve replacement in patients with free PR after TOF repair is of outermost clinical relevance. This study examined the impact of free PR on RV in a pig model. Despite the relative short duration of the volume overload, the RV underwent irreversible changes. This may be explained by the fact that, in contrast to TOF, the RV is not hypertrophic. The study showed that RV tolerates volume overload from free PR for a certain time, but too late intervention will cause irreversible deterioration of the ventricular function. Thus, the model may serve to identify predictors, e.g. tissue-Doppler measurements or natriuretic peptides, for RV function after valve replacement and thereby optimise timing of intervention.

scholarly journals Reduction of QRS duration after pulmonary valve replacement in adult Fallot patients is related to reduction of right ventricular volume

2005 ◽  
Vol 26 (9) ◽  
pp. 928-932 ◽  
Author(s):  
Bart Hooft van Huysduynen ◽  
Alexander van Straten ◽  
Cees A. Swenne ◽  
Arie C. Maan ◽  
Henk J. Ritsema van Eck ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Ventricular Volume ◽  
Pulmonary Valve Replacement ◽  
Right Ventricular Volume ◽  
Qrs Duration

scholarly journals Percutaneous pulmonary valve implantation in patients with right ventricular outflow tract dysfunction: a systematic review and meta-analysis

2019 ◽  
Vol 10 ◽  
pp. 204062231985763 ◽  
Author(s):  
Liyu Ran ◽  
Wuwan Wang ◽  
Francesco Secchi ◽  
Yajie Xiang ◽  
Wenhai Shi ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve

Background: Pulmonary valve replacement is required for patients with right ventricular outflow tract (RVOT) dysfunction. Surgical and percutaneous pulmonary valve replacement are the treatment options. Percutaneous pulmonary valve implantation (PPVI) provides a less-invasive therapy for patients. The aim of this study was to evaluate the effectiveness and safety of PPVI and the optimal time for implantation. Methods: We searched PubMed, EMBASE, Clinical Trial, and Google Scholar databases covering the period until May 2018. The primary effectiveness endpoint was the mean RVOT gradient; the secondary endpoints were the pulmonary regurgitation fraction, left and right ventricular end-diastolic and systolic volume indexes, and left ventricular ejection fraction. The safety endpoints were the complication rates. Results: A total of 20 studies with 1246 participants enrolled were conducted. The RVOT gradient decreased significantly [weighted mean difference (WMD) = −19.63 mmHg; 95% confidence interval (CI): −21.15, −18.11; p < 0.001]. The right ventricular end-diastolic volume index (RVEDVi) was improved (WMD = −17.59 ml/m²; 95% CI: −20.93, −14.24; p < 0.001), but patients with a preoperative RVEDVi >140 ml/m² did not reach the normal size. Pulmonary regurgitation fraction (PRF) was notably decreased (WMD = −26.27%, 95% CI: −34.29, −18.25; p < 0.001). The procedure success rate was 99% (95% CI: 98–99), with a stent fracture rate of 5% (95% CI: 4–6), the pooled infective endocarditis rate was 2% (95% CI: 1–4), and the incidence of reintervention was 5% (95% CI: 4–6). Conclusions: In patients with RVOT dysfunction, PPVI can relieve right ventricular remodeling, improving hemodynamic and clinical outcomes.

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