Transcatheter pulmonary valve replacement after arterial switch operation

• Published in: Catheterization and cardiovascular interventions 2024-09, Vol.104 (3), p.531-539
• Main Authors: Nageotte, Stephen, Salavitabar, Arash, Zablah, Jenny E., Ligon, R. Allen, Turner, Mariel E., El‐Said, Howaida, Guyon, Peter, Boucek, Dana, Alvarez‐Fuente, Maria, McElhinney, Doff B., Balzer, David, Shahanavaz, Shabana
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aorta; Arterial Switch Operation - adverse effects; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Child; Child, Preschool; Compression; Coronary artery disease; coronary compression; d‐transposition of the great arteries; Embolization; Feasibility Studies; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Hemodynamics; Humans; Infant; Male; Pulmonary Valve - diagnostic imaging; Pulmonary Valve - physiopathology; Pulmonary Valve - surgery; Pulmonary Valve Insufficiency - diagnostic imaging; Pulmonary Valve Insufficiency - etiology; Pulmonary Valve Insufficiency - physiopathology; Pulmonary Valve Insufficiency - surgery; Pulmonary Valve Stenosis - diagnostic imaging; Pulmonary Valve Stenosis - etiology; Pulmonary Valve Stenosis - physiopathology; Pulmonary Valve Stenosis - surgery; Recovery of Function; Regurgitation; Retrospective Studies; Risk Factors; Stenosis; Time Factors; transcatheter pulmonary valve replacement; Transposition; Transposition of Great Vessels - diagnostic imaging; Transposition of Great Vessels - physiopathology; Transposition of Great Vessels - surgery; Treatment Outcome; United States; Ventricular Function, Right; Ventricular Outflow Obstruction - diagnostic imaging; Ventricular Outflow Obstruction - etiology; Ventricular Outflow Obstruction - physiopathology; Ventricular Outflow Obstruction - surgery; Young Adult
• ISSN: 1522-1946; 1522-726X; 1522-726X
• DOI: 10.1002/ccd.31152

Background Patients with d‐transposition of the great arteries (d‐TGA) who have undergone an arterial switch operation (ASO) can develop right ventricular outflow tract (RVOT) dysfunction with pulmonary regurgitation (PR) or stenosis. In these patients, treatment may include transcatheter pulmonary valve replacement (TPVR). Coronary compression is a contraindication occurring in 5% of typical TPVR cases. After ASO, there are various anatomical considerations that can confound TPVR, including potential coronary artery compression. Our goal is to understand feasibility of TPVR in patients following ASO. Methods This was a retrospective multicenter cohort study of patients with RVOT dysfunction after ASO who underwent cardiac catheterization with intention to perform TPVR from 2008 to 2020. Results Across nine centers, 33 patients met inclusion criteria. TPVR was successful in 22 patients (66%), 19 receiving a Melody valve and 3 a SAPIEN valve. RVOT stenosis in isolation or with PR dictated need for TPVR in nearly all patients. One serious adverse event occurred with valve embolization. After TPVR, the RVOT peak gradient decreased from 43 to 9 mm Hg (p