Current Treatment Options for Catheter-Based Pulmonary Valve Replacement in Children
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Cardiology/CT Surgery (K Gist, Section Editor)
Current Treatment Options for Catheter-Based Pulmonary Valve Replacement in Children Jenny E. Zablah, MD, FACC, FAAP, FSCAI* Gareth J. Morgan, MB BaO BCH, MRCPCH MPhil FSCAI Address * Congenital Interventional Cardiologist, Children’s Hospital Colorado, University of Colorado School of Medicine, Box 100, 13123 East 16th Avenue, Aurora, CO, 80045, USA Email: [email protected]
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Cardiology/CT Surgery Keywords Percutaneous pulmonary valve I Hybrid techniques I Native outflow tract I Pulmonary valve replacement
Abstract Purpose of review For decades, surgical replacement of the pulmonary valve has been the gold standard. The last 10 years have seen significant progress in improvement in the technology and techniques around percutaneous pulmonary valve Percutaneous pulmonary valve replacement (PPVR). This has allowed us to expand the range of patients who can be treated with percutaneous techniques. This review serves as an update for referring cardiologists. Recent developments Several studies have demonstrated similar clinical outcomes comparing surgical and percutaneous valve replacement, noting the decreased recovery time and morbidity after PPVR. Along with the overall periprocedural advantages of PPVR, newer devices now allow pulmonary valve replacement in patients with surgically placed conduits and in patients with dilated native right ventricular outflow tracts (RVOT). PPVR is now also performed in smaller patients thanks to newly available techniques and technology. Imaging technology to guide these procedures has also evolved allowing such complex interventions to be performed with minimal radiation and contrast use in the catheterization laboratory. Summary knowledge of technological advancements in PPVR will allow referring cardiologists and patients to make informed decisions about pulmonary valve replacement in each individual case. Technology will continue to evolve and hopefully provide many more surgical and percutaneous options to care for the congenital heart disease population.
Introduction For over a decade, there has been a huge drive to expand the range of patients who can be treated with percutaneous
techniques [1]. Percutaneous pulmonary valve implantation (PPVR) has always demonstrated the same efficacy as
Cardiology/CT Surgery (K Gist, Section Editor) surgical pulmonary valve replacement with right ventricular (RV) remodeling and improvements in symptoms at New York Heart Association (NYHA) class. Currently, there are two percutaneous valves approved in the United States (U.S.) for placement in the pulmonary position: The Melody® valve and the Edwards SAPIEN® valves. These allow treatment of a considerable proportion of patients. There are two ongoing clinical trials in the U.S. that aim to expand the range of PPVR options to include patients with severely dilated right ventricular outflow tracts (RVOTs). One of the trials involves a sel
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