More than Ten Years of Experience with Percutaneous Pulmonary Valve Implantation

Percutaneous pulmonary valve implantation (PPVI) emerged to be the first line treatment option for suitable patients with right ventricular outflow tract (RVOT) dysfunction in many centers. We report on our > ten year experience with PPVI.

Since December 2006, a total of 234 patients (female 80) were treated with PPVI. In 219 patients a Medtronic Melody valve was used and in 15 patients an Edwards Sapien valve was implanted (23 mm n = 3, 26 mm n = 8, 29 mm n = 4). Median patient age was 18.1 years (range: 4.1–78.9 years), weight was 59 kg (19–176 kg). Diagnoses: TOF/PA+VSD 116, common arterial trunk 40, TGA after Rastelli 20, AoS after Ross 26, and miscellaneous 32. The valves were placed in a bioprosthesis in 209 patients, a “native” RVOT was present in 25 patients. Nearly all patients had prestenting of the RVOT with a variety of stents. Periprocedural mortality was 2/234 (0.8%, coronary occlusion 1, fatal conduit rupture 1). The gradient in the RVOT was lowered from 38 to 10 mm Hg (p < 0.001) and the RV:aortic pressure ratio fell from 67 to 36% respectively (p < 0.001). During a follow-up of 922 patient years 91% of all patients still live with the percutaneously implanted pulmonic valve; 15 valves had to be explanted due to endocarditis (8), outgrowth (7) and in six patients a valve in valve procedure was performed.

In conclusion PPVI can be performed after careful patient selection with a low periprocedural morbidity and mortality. Coronary compression and conduit rupture are the procedural hazards. Long-term results are promising but lifelong surveillance is necessary.

 

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