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European Heart Journal Advance Access published online on March 3, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn073
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Percutaneous pulmonary valve-in-valve implantation: a successful treatment concept for early device failure

Johannes Nordmeyer1, Louise Coats1, Philipp Lurz1, Twin-Yen Lee1, Graham Derrick1, Philipp Rees1, Seamus Cullen2, Andrew M. Taylor1, Sachin Khambadkone1 and Philipp Bonhoeffer1,*

1 Cardiothoracic Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London WC1N 3JH, UK
2 The Heart Hospital, London, UK

Received 22 September 2007; revised 19 December 2007; accepted 31 January 2008.

* Corresponding author. Tel: +44 20 7813 8106, Fax: +44 20 7813 8262, Email: bonhop{at}gosh.nhs.uk

Aims: Percutaneous pulmonary valve implantation (PPVI) is now an accepted treatment strategy for right ventricular (RV) outflow tract (RVOT) dysfunction in many European Heart Centres. We analysed the efficacy of repeat PPVI as a treatment modality for early device failure.

Methods and results: Twenty patients underwent repeat PPVI for RVOT obstruction because of early device failure (‘Hammock effect’, ‘Hammock-like effect’, stent fracture, residual stenosis). Repeat PPVI was feasible in all patients with no procedural complications. Following implantation of a second device, catheter-measured RVOT gradient and RV systolic pressure fell significantly (RVOT gradient: 46.1 ± 3.9 to 18.1 ± 2.4 mmHg, P < 0.001; RVSP: 70.9 ± 4.8 to 46.1 ± 2.6 mmHg, P < 0.001), in all but one patient (15 years, male, common arterial trunk, 11.5 mm homograft). During follow-up, four of 20 required re-intervention [third PPVI for stent fracture (n = 2), device explantation: external compression by the sternum (n = 1), endocarditis (n = 1)], and one of the 20 is awaiting surgical management. In the remainder, second PPVI resulted in a sustained improvement in haemodynamics with a mean follow-up of 10.9 ± 3.0 months. In this series, the probability of freedom from re-intervention at 2 years was higher after second PPVI when compared with the index procedure (89.4 vs. 20.0%, P < 0.001).

Conclusion: Repeat PPVI is an effective treatment for early device failure in defined conditions and leads to improved freedom from re-intervention.

Key Words: Catheterization • Percutaneous pulmonary valve • Congenital heart disease


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