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Transcatheter valve replacement in congenital heart disease: the present and the future

Heart (British Cardiac Society), 2018-10, Vol.104 (19), p.1629-1636 [Peer Reviewed Journal]

Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. ;2018 Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. ;ISSN: 1355-6037 ;EISSN: 1468-201X ;DOI: 10.1136/heartjnl-2016-310898 ;PMID: 29490935

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Title:
Transcatheter valve replacement in congenital heart disease: the present and the future
Author: Ghobrial, Joanna ; Aboulhosn, Jamil
Subjects: Cardiac Catheterization - adverse effects ; Cardiac Catheterization - instrumentation ; Cardiac Catheterization - methods ; Cardiac Catheterization - trends ; Cardiology ; Cardiovascular disease ; Catheters ; Clinical trials ; Congenital diseases ; Diffusion of Innovation ; Electrocardiography ; Forecasting ; Heart ; Heart Defects, Congenital - complications ; Heart Defects, Congenital - diagnostic imaging ; Heart Defects, Congenital - physiopathology ; Heart Valve Diseases - congenital ; Heart Valve Diseases - diagnostic imaging ; Heart Valve Diseases - physiopathology ; Heart Valve Diseases - surgery ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation - adverse effects ; Heart Valve Prosthesis Implantation - instrumentation ; Heart Valve Prosthesis Implantation - methods ; Heart Valve Prosthesis Implantation - trends ; Heart Valves - abnormalities ; Heart Valves - diagnostic imaging ; Heart Valves - physiopathology ; Heart Valves - surgery ; Humans ; Mortality ; Prostheses ; Prosthesis Design ; Pulmonary arteries ; Recovery of Function ; Treatment Outcome ; Veins & arteries
Is Part Of: Heart (British Cardiac Society), 2018-10, Vol.104 (19), p.1629-1636
Description: Many of them will need multiple valve surgeries over their lifetime, which increases their risk of morbidity and mortality.1 The advances in interventional cardiology and the introduction of the Melody valve, a balloon expandable pulmonary valve2 in 2000 have radically altered the management options for these patients by reducing the need for redo surgical interventions.3 We herein discuss the existing and future catheter-based valve replacement and repair options for adult CHD. Studies evaluating the timing of PVR in patients with severe chronic PR have suggested that normalisation of right ventricular (RV) volume will not occur if severe dilation has already ensued (indexed RV end-diastolic volume >150 mL/m2 or indexed RV end-systolic volume >80 mL/m2).6–8 Furthermore, it is likely that earlier PVR could result in improved exercise tolerance especially in patients with predominant PS.9 10 While there is little evidence that such an approach results in improved clinical outcomes such as decreased mortality, some experts argue that all patients with RV outflow dysfunction (PR, PS or both) should undergo PVR prior to the development of RV dilation or dysfunction.9 The introduction of transcatheter valve therapies is lowering the threshold for PVR, however, this approach must be weighed against the potential for infective endocarditis (IE), procedural risks and decrease in internal diameter of the conduits secondary to multiple transcatheter valve implants.11 Transcatheter PVR (TPVR) can alleviate RV outflow tract (RVOT) conduit dysfunction whether due to stenosis or regurgitation or both. Potential complications of TAVR include perivalvular leak, conduction abnormalities, thromboembolism, valve embolisation, aortic root rupture, coronary occlusion and iliac artery rupture.43 TAVR in AS due to bicuspid aortic valve has been shown to be feasible and effective with favourable valve performance, and similar outcomes as TAVR in trileaflet AS, and while some studies demonstrated a higher rate of PVL compared with TAVR in trileaflet AS, the newer generation valves, such as the Sapien 3 and the Lotus valve show lower rates of perivalvular leak (PVL).44 45 In our experience, TAVR in patients with other forms of CHD is feasible, such as a patient with D -transposition of the great arteries status postarterial switch and valve sparing aortic root repair with recurrent AR (figure 4). Furthermore, the Melody valve has been modified and surgically placed in all four valvular positions as an expandable valve in infants and children allowing for future balloon dilations and by that accommodating somatic outgrowth, hopefully reducing the number of future surgeries.48 49 Importantly, while transcatheter valve implantation in CHD is reducing the need for surgical intervention, with its associated morbidities, as well as getting women through childbearing age without the need for systemic anticoagulation as would be necessary with mechanical valves, the trade-off is the concern for valve durability, and the need for reintervention relative to the surgical valves, especially as these valves are being implanted at a much younger age in patients with CHD.
Publisher: England: BMJ Publishing Group LTD
Language: English
Identifier: ISSN: 1355-6037
EISSN: 1468-201X
DOI: 10.1136/heartjnl-2016-310898
PMID: 29490935
Source: MEDLINE
ProQuest Central

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Transcatheter valve replacement in congenital heart disease: the present and the future

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