Percutaneous Pulmonary Valve Implantation: Lessons We Have Learned
Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Technical University Munich ◇ Germany
Percutaneous pulmonary valve implantation (PPVI), introduced two years before transcutaneous aortic valve implantation (TAVI) is one of the most successful recent improvements in catheter interventional treatment of patients with congenital heart disease and dysfunction of the right ventricular outflow tract (RVOT). At adolescence, many patients with complex cardiac lesions involving the RVOT have experienced several open heart surgeries. Repeated open heart operations are associated with significant morbidity and even mortality. The Melody® valve was initially introduced to expand the life time of a biological valve in the RVOT and hence to reduce the total number of open heart surgeries during a patients life time. The advent of the Sapien® valve now enables treatment of RVOT’s as large as 31 mm in diameter and even patients with so called “native” right ventricular outflow tracts (without a biological valved conduit) are amenable to treatment with a percutaneous valve. PPVI is safe and effective and patients can be discharged home after a few days in the hospital. Coronary occlusion and conduit rupture are the major hazards of the intervention. Long-term data on valve durability now show similar results in comparison to surgical valve implantation with less morbidity for the patients. Currently new self expanding valves are tested, which could enhance the possibility for patient selection. This review describes current practice, adds own experience, lessons learned and gives an outline on future developments in PPVI.
Key words: percutaneous pulmonary valve implantation; right ventricular outflow tract dysfuncion
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