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.
