Percutaneous Pulmonary Valve Implantation (PPVI) in Australia and New Zealand (ANZ)

Abstract

Background: The ANZ population undergoing PPVI, including short to medium term outcomes, has not been fully characterised. In particular, there are concerns about infective endocarditis (IE) risk. Methods: A multi-site retrospective cohort study across seven centres in ANZ. PPVI cases were identified using institutional databases and relevant details collected. Key outcomes evaluated at follow-up included mortality, morbidity (repeat procedure, infective endocarditis) and echocardiographic data. Results: From June 2009-March 2018, 134 individuals underwent PPVI utilising 123 Medtronic Melody™ valves and 11 Edwards SAPIEN valves (median age 18 years, range 9–60 years; median weight 59 kg, range 24–137 kg). Common underlying diagnoses were tetralogy of Fallot (n = 44, 33%) and pulmonary atresia +/- ventricular septal defect (n = 26, 19%). The most common previously employed conduit was a homograft (n = 91, 67%). Indications for PPVI included conduit stenosis (n = 75, 56%), regurgitation (n = 12, 9%) or mixed disease (n = 47, 35%). Immediate haemodynamic outcome was good; the peak stenotic gradient decreased from mean 40 mmHg to mean 11 mmHg (p = 0.047). Risk of severe procedural complication was low. There was one early post procedural death; due to device embolisation within the RVOT. In follow-up (median 21 months, range 0–98 months), there were two further deaths, unrelated to PPVI. Thirteen individuals developed IE (annualised incidence rate 4.6% per patient-year), 9 of these individuals required valve re-replacement. Two further individuals underwent valve replacement without IE. Conclusions: PPVI as performed in selected ANZ centres provides a relatively safe and feasible method of rehabilitating the RVOT.L20022345342019-08-01 <br />