Jan 6th 2022

Single-Barrel, Double-Barrel, and Fenestrated Endografts to Facilitate Transcatheter Pulmonary Valve Replacement in Large RVOT

The authors report on a unique series of eight patients with severe pulmonary insufficiency and RVOTs too large for conventional transcatheter pulmonary valves and who were prohibitive surgical risk and ineligible for investigational devices. 

Published December 14th 2020. 

They report using novel techniques involving endograft-facilitated transcatheter pulmonary valve replacement (EF-TPVR).

The authors used three different methods of EF-TPVR: single-barrel, in situ fenestrated, and double-barrel depending on the anatomical characteristics of each patient (generally the size of the MPA and RVOT: 28-30 mm, single-barrel; 30-40 mm, fenestrated; >40 mm, double-barrel).

The authors detail the pre-procedural planning and imaging required for such an approach and step-by-step details of each.

Finally, the authors compared a contemporary cohort of patients receiving surgically implanted pulmonary valves.

The follow-up duration was significantly shorter in the EF-TPVR patients; however, there was no difference in mortality or readmission rate out to one year. In addition, the mean pressure gradient across the bioprosthetic valve was lower in the EF-TPVR group, and there was no difference in the incidence of > mild pulmonary insufficiency.

This paper details three approaches to dealing with very complex dilated RVOTs. Hopefully, with the advent of newly approved devices such as the Harmony valve, the need for such approaches will be minimized. However, the interventional cardiologist needs to be familiar with this paper if the need arises to treat selected patients.

All editors: David T. Balzer, MD, FSCAI