Skip Navigation



European Heart Journal Advance Access published online on March 3, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn073
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
29/6/810    most recent
ehn073v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Nordmeyer, J.
Right arrow Articles by Bonhoeffer, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Nordmeyer, J.
Right arrow Articles by Bonhoeffer, P.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

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


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.