Percutaneous pulmonary valve implantation in children and adults with 5 years follow up: single centre experience
Authors: Nirmal N , Kotidis C , Kantzis M 
Published: October 2021

Abstract

Introduction
Percutaneous pulmonary valve implantation (PPVI) is an established alternative to the surgical approach to treat right ventricular outflow tract (RVOT) dysfunction in patients with congenital heart diseases. Previous reports have found favourable long term outcomes with low rates of complications.

Aim
To report clinical outcomes up to 5 years following PPVI in a mixed population of paediatric and adult patients with CHD from a single centre in UK and compare it with national and international standards.

Methods
Single-centre retrospective study of patients referred for PPVI between January 2013 and June 2020. Clinical data (demographics, echocardiography, MRI scan, invasive haemodynamic and cardiopulmonary exercise test data) were retrieved from case notes and electronic database (Heartsuite) before and after PPVI (follow up (FU) at 1, 6, 12 months and then annually until 5 years). For comparison the patient population was divided as following: pulmonary stenosis (PS), mixed pulmonary valve disease (mPD) or pulmonary regurgitation (PR). Medtronic Melody or Edwards Sapien (S3, XT and Ultra) valves were used. Statistical analysis was performed using SPSS (median and interquartile range (IQR) for demographics and Wilcoxon signed rank test for comparisons). Statistical significance was set at P&lt;0.05.

Results
63 patients were referred for PPVI (adults 54 patients and children 9 patients). 18 patients (29%) were deemed unsuitable for PPVI due to mismatch between RVOT size and the largest available valve in the market or coronaries being in close proximity to RVOT. 45 patients underwent a PPVI and their background demographics and clinical outcomes are shown in Table 1. One patient had perioperative severe PR and underwent conduit change on the next day. There was significant reduction in median RVOT velocity following PPVI in all patients with previous PS or mPD [median (IQR), 4.1 (0.5) vs. 2.8 (1.0) m/sec, (P&lt;0.001) and this result remained up to 5 years (4.1 (0.5) vs. 2.8 (1.1), P=0.012). Independent of the valve type used there was significant reduction of the RVOT velocity in the immediate post-PPVI period [Edwards (P=0.001, Melody (P=0.013)], (Figure 1). No patient had clinically significant PR (PR≥moderate) following PPVI (mild PR=6/45) and this persisted up to 5 years FU. There was reduction in MRI measured median RV volumes following the PPVI in patients with pulmonary regurgitation which was approaching statistical significance (end diastolic volume 194 (110) vs. 142 (80), P=0.051 and end systolic volume 113 (117) vs. 95 (56)ml/m2, P=0.061, N=5). Two adults died from non-cardiac reasons during FU. No patients required reintervention.

Conclusion
PPVI remains an alternative to surgery with a high success and low complication rates. RVOT velocity and PR at five years follow up remain in levels not requiring any further intervention and this was accompanied by improvement of NYHA status.

Funding Acknowledgement
Type of funding sources: None.