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Transcatheter Pulmonary Valve Implantation experience in a Portuguese Congenital Heart Disease Center
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 09 - CARDIOLOGIA DE INTERVENÇÃO/ESTRUTURAL
Speaker:
Ana Isabel Pinho
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Isabel Pinho; Ana Filipa Amador; Marisa Pereira; João Carlos Silva; Jorge Moreira; Edite Pereira; Maria João Baptista; Sofia Granja; Carla Sousa; Rui André Rodrigues; Cristina Cruz
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">Background: Right ventricular outflow tract (RVOT) obstruction occurs in various congenital heart defects. Following surgical repair, patients often experience residual pulmonic stenosis and/or insufficiency in the native outflow tract or the right ventricle to pulmonary artery (RV-to-PA) conduit. As an alternative to surgical pulmonary valve replacement (PVR), the introduction of transcatheter pulmonary valve implantation (TPVI) at the early 2000 has provided a less invasive treatment option.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Aim: To analyse the indications, procedure-related characteristics and follow up of patients submitted to TPVI in a Portuguese Congenital Heart Disease Reference Center (start of program in 2015).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Results: Twenty-two patients were proposed and assessed as fit to TPVI; mean age 25.3 years-old (range 10-51 years-old), 11 (50%) were male, 2 patients had DiGeorge Syndrome. The primary diagnosis were: Tetralogy of Fallot (45.5%), Truncus Arteriosus (31.8%), pulmonary stenosis related to D-transposition of the great arteries (18.2%) and to double outlet right ventricle (4.5%). Mean number of open-heart surgeries was 1.6; there was RV-to-PA conduits in 12 patients, patch-extended RVOT in 9 and 1 patient had previously implanted a percutaneous pulmonary valve. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Primary indication for TPVI was stenosis (45.4%), followed by regurgitation (40.9%) and mixed lesion in 13.6%. All patients underwent general anaesthesia and femoral access; 20 completed implantation with success; one procedure was aborted due to coronary anatomy (risk of left main artery occlusion) and another was interrupted due to obstruction of right pulmonary artery after RVOT stenting. Pre-stenting was performed in 16 patients, with a mean number of 1.9 (range 1-5) stents. Regarding the type of valve, 90% were balloon expandable (11 Melody, 4 MyVal and 3 Sapiens) and the remaining 2 patients had an auto expandable Vennus Valve implanted. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Complications were registered in 3 (13.6%) patients – 1 had obstruction of PA branches with need for surgical intervention, 1 had balloon rupture retrieved percutaneously, and another suffered bleeding from vascular access, managed conservatively. </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">During a mean follow-up time of 3.8 years, there were no deaths nor valve thrombosis; one patient with Melody valve had stent fracture. Four patients evolved with moderate pulmonary stenosis, asymptomatic. Three patients had late endocarditis of prosthesis, all treated with antibiotic and surgical PVR.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Conclusions: In this cohort, TPVI procedure had few complications and the short-medium term outcomes were favourable. Questions over endocarditis risk still prevail in the TPVI population and there is need for head-to-head comparisons to PVR. </span></span></span></p>
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