Giacomo Pongiglione
Ospedale Pediatrico Bambino Gesù, Italy
Title: Pulmonary Valve implantation in the Native Outflow Tract
Biography
Biography: Giacomo Pongiglione
Abstract
RVOT reconstruction is a significant component of many surgical repairs and residual RVOT dysfunction (stenosis and/or regurgitation) forms the primary indication for reoperation. Percutaneous PV implantation has been introduced to reduce the number of operations needed in the total lifetime of the pts. with a RVOT dysfunction and hundreds of PV have been implanted in condouits. Pulmonary valve implantation is now current practice in the treatment of failing conduits in the RVOT. However, the vast majority of Tetralogy of Fallot received transannular patch repair of the RVOT. Pulmonary regurgitation is frequent after conduit insertion and is an inevitable consequence of transannular patching and/or pulm. valvotomy and will eventually compromise RV function. The patched outflow tract does not offer a rigid support for percutaneous pulmonary valve implantation, limiting the possibility of a catheter based treatment. From October 2010 through December 2014, a trans-catheter implantation of a prosthetic pulmonary valve has been performed succesfully on 45 patients, 27 of which had a transannula patch. A protocol of RVOT pre-stenting followed after 1-2 months by valve implantation has been utilized. One patient underwent surgery because of stent malposition, early in our experience, as well as 5 additional pts. in which the procedure was aborted because of coronary proximity or RVOT size. A succesful valve implantation was obtained in 21 patients. At a mean follow-up of 19 months all pts improved from NYHA II-III to I, there was no significant PV insufficiency or stenosis, mean RV pressure was 25±9 mmHg, and there has been no stent migration or stent fractures.