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Transcatheter pulmonary valve replacement promising in small children
Transcatheter pulmonary valve replacement was associated with improvements in peak conduit gradient in a cohort of children who were less than 30 kg in size, according to new research.
Although the Melody transcatheter pulmonary valve (Medtronic) has FDA approval for patients who weigh greater than 30 kg, limited data exist for this device in smaller patients, according to the investigators.
The current analysis included 25 children who weighed less than 30 kg, 10 of whom were less than 20 kg. Participants underwent the procedure for conduit dysfunction and were evaluated for technical and short-term clinical outcomes.
The median age of participants was 8 years (3.4-14.4) and weight was 21.4 kg (13.8-29).
At implantation, a median conduit diameter of 17 mm (12-23) was reported.
Risk of coronary compression prevented one patient from undergoing the procedure, while another failed to undergo the procedure due to an inability to advance the delivery sheath beyond the common femoral vein.
Peak conduit gradient decreased from 29 ± 16 to 9 ± 6 mm Hg (P<.001) after successful implantation of the transcatheter pulmonary valve. No regurgitation or trivial regurgitation occurred in all patients except two. Before the procedure, 20 patients demonstrated moderate or severe regurgitation.
Seventeen patients received the implant via the femoral vein, four received it via the right internal jugular vein and two via the left subclavian vein.
The median follow-up duration was 16 months. At that point, one patient required conduit replacement for recurrent conduit stenosis. Stent fracture requiring a second transcatheter pulmonary valve occurred in two patients, while two others developed bacterial endocarditis that required antibiotic therapy. One of the patients with endocarditis subsequently underwent conduit replacement.
“The average Melody valve mean Doppler gradient and conduit regurgitation were unchanged from early postimplant,” the researchers concluded, adding that percutaneous transcatheter pulmonary valve replacement may be an attractive option for the majority of small children.
Disclosure: Four investigators report serving as proctors and consultants for Medtronic.