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Study finds risk factor, treatment for RVOT conduit disruption
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Occurring in 6% of patients, right ventricular outflow tract conduit disruption during transcatheter pulmonary valve replacement was associated with a higher conduit systolic pressure gradient, and could be prevented or treated safely with the use of a covered Cheatham-platinum stent, researchers found.
According to Ram N. Bishnoi, MD, from the division of pediatric cardiology at Johns Hopkins School of Medicine and Bloomberg Children’s Center in Baltimore, and colleagues, there are currently no published reports detailing the safety and efficacy of covered stents for the prevention or treatment of right ventricular outflow tract (RVOT) conduit disruption during transcatheter pulmonary valve replacement (TPVR).
Bishnoi and colleagues retrospectively reviewed 251 TPVR procedures performed at several U.S. investigational sites. They also analyzed data on the use of 69 covered Cheatham-platinum stents (CCPS; NuMED) in 50 patients during the TPVR procedure.
Results indicated that the incidence of conduit disruption requiring intervention was 6%, and that the only predictor was a very elevated RVOT conduit systolic pressure gradient.
Overall, there were pre-existing conduit tears in nine patients, 31 tears after conduit dilation, and three tears after TPVR.
Seven patients underwent prophylactic treatment with CCPS.
Clinicians prevented or repaired conduit tears in 49 of 50 patients, with no CCPS-related acute complications reported.
At 6 months, there were no cases of more than mild pulmonary regurgitation, and the mean Doppler RVOT gradient was better than that from the Melody TPV Investigational Device Exemption trial (12.7 ± 5.8 mm Hg vs. 20 ± 8.6 mm Hg), according to the researchers.
“These data support the need to have access to the CCPS when performing TPVR procedures, as the occurrence of RVOT conduit disruption appears to be unpredictable,” Bishnoi and colleagues wrote. – by Brian Ellis
Disclosure: Bishnoi reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.
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