Relationships Among Conduit Type, Pre-Stenting, and Outcomes in Patients Undergoing Transcatheter Pulmonary Valve Replacement in the Prospective North American and European Melody Valve Trials
Relationships Among Conduit Type, Pre-Stenting, and Outcomes in Patients Undergoing Transcatheter Pulmonary Valve Replacement in the Prospective North American and European Melody Valve Trials
复制标题
DOI：
10.1016/j.jcin.2017.05.022
复制
发表时间：
2017-09-11
影响因子：
11.3
通讯作者：
McElhinney, Doff B.
中科院分区：
文献类型：
--
作者：
Cabalka, Allison K.;Hellenbrand, William E.;McElhinney, Doff B.
背景支架断裂（SF）和右心室流出道（RVOT）再介入是使用Melody瓣膜（Medtronic，Minneapolis，Minnesota）的TPVR后最重要的不良结局之一。TPVR.METHODS 3个前瞻性Melody瓣膜多中心研究的数据进行汇总和分析。出院时成功植入Melody瓣膜的所有患者组成研究队列;将TPVR植入无支架管道的患者组成分析队列。SF的诊断使用协议规定的或临床的荧光透视或放射摄影，并分为主要或minor.Results的358例患者进行导管插入术，意图执行TPVR，309出院的旋律阀到位（研究队列），其中251例患者TPVR到无支架管道（分析队列）。中位随访时间为5年。68%的无支架管道患者植入了新的预支架，22%的患者植入了多个预支架。3年时，无任何SF和重大SF的比例分别为74 +/- 3%和85 +/-2%，无RVOT再干预的比例为85 +/-2%。新的预支架与更长的自由SF和RVOT再介入比没有prestent.CONCLUSIONS风险SF和再介入后TPVR与旋律阀植入预支架，这已成为标准的做法。本研究支持将支架植入前作为TPVR治疗的重要组成部分。(C)2017由Elsevier代表美国心脏病学会基金会发布。
OBJECTIVES This study sought to evaluate the incidence of and risk factors for conduit and stent-related outcomes following transcatheter pulmonary valve replacement (TPVR).BACKGROUND Stent fracture (SF) and right ventricular outflow tract (RVOT) reintervention are among the most important adverse outcomes after TPVR using the Melody valve (Medtronic, Minneapolis, Minnesota). The conduit environment and conduit preparation practices vary among patients who undergo TPVR.METHODS Data from 3 prospective Melody valve multicenter studies were pooled and analyzed. All patients who had successful implant of a Melody valve that was present at hospital discharge comprised the study cohort; patients who had TPVR into a stentless conduit comprised the analysis cohort. SF was diagnosed using protocol-specified or clinical fluoroscopy or radiography, and classified as major or minor.RESULTS Of 358 patients who underwent catheterization with intent to perform TPVR, 309 were discharged with the Melody valve in place (study cohort) of which 251 patients had TPVR into a stentless conduit (analysis cohort). Median follow-up was 5 years. New pre-stents were placed in 68% of patients with a stentless conduit, and 22% received multiple pre-stents. At 3 years, freedom from any SF and major SF was 74 +/- 3% and 85 +/- 2%, respectively, and freedom from RVOT reintervention was 85 +/- 2%. New pre-stents were associated with longer freedom from SF and RVOT reintervention than was no pre-stent.CONCLUSIONS Risks of SF and reintervention after TPVR with a Melody valve were reduced by implantation of pre-stents, which has become standard practice. This study supports pre-stenting as an important component of TPVR therapy. (C) 2017 Published by Elsevier on behalf of the American College of Cardiology Foundation.