Native valve, Conduit stenosis or leakage? How can the interventionalist help?
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1 Complications in Congenital Heart Diseases -with a little help of our friends Native valve, Conduit stenosis or leakage? How can the interventionalist help? P. Ewert German Heart Center Munich Lausanne 6/2015
2 Complications in Congenital Heart Diseases with a little help of our friends How can the interventionalist help???
3 10 Development of percutaneous pulmonary valve replacement
4 How long did a transcatheter valve last? Survival without valve dysfunction n = 160 mean FU 3.0 years 470 patient years 15 events 5 deaths 3 valve in valve 7 surgical valve replacements years
5 Complications in Congenital Heart Diseases -with a little help of our friends Native valve, Conduit stenosis or leakage? How can the interventionalist help????
6 Transcatheter valve replacement Pulmonary valve transcath. intervention vs. surgery - minimally invasive - short hospital stay - 16 yrs experience - modest reimbursement - cardiopulmonary bypass - longer hospital stay - (longer experience) - better reimbursement
7 Pulmonary valve replacement The dilemma of optimal timing (re-do surgery) Risks of Repeated Surgeries Risks of Irreversible RV Failure
8 Transcatheter valve replacement Risks of surgical pulmonary valve implantation Situs without pre-operations
9 Transcatheter valve replacement Risks of surgical pulmonary valve implantation re-re-re- do Courtesy P. Bonhoeffer aorta behind sternum coronaries CPB
10 Transcatheter valve replacement Melodyklappe in Conduit
11 Transcatheter valve replacement originally designed as re-doprocedure calcified homograft
12 Comparison of outcome surgery catheter
13 Transcatheter valve replacement Risks of transcatheter pulmonary valve implantation conduit rupture
14 Transcatheter valve replacement Risks of transcatheter pulmonary valve implantation Exclude coronary compression before stent implantation
15 Transcatheter valve replacement Comparison of the individual surgical vs. interventional risk high risk of coronary compression only once operated before => surgery!
16 Transcatheter valve replacement Comparison of the individual surgical vs. interventional risk re-re-re- op Transcatheter pulmonary valve replacement in a 72 yrs old pt.
17 transcatheter valve replacement technical limitations 22F delivery system 18kg BW
18 transcatheter valve replacement technical limitations 14mm Melody 3.4 yrs. 16kg, 12 mm Contegra
19 Native Outflow Tract and Transannular Patch Conduit Pulmonary valve implantations German Heart Center n = native
20 Native Outflow Tract and Transannular Patch 157 Andra-Stent implanted with 26mm balloon
21 Native Outflow Tract and Transannular Patch 157 Melody implanted with 24 mm balloon
22 Balloon interrogation in native outflowtract native outflowtract LPA stent for anchoring a valve
23 Anchoring a long stent in the LPA stent 48mm Andra Stent on a 18mm BiB
24 Selective dilatation of the proximal stent 25mm Maxi, Cordis
25 Melody valve implantation Elongation of landing zone with longer Andra Stent Melody implantation in cage de-jailing of the RPA with Atlas-Balloon
26 Melody valve implantation Final result
27 Percutaneous valve implantation in large RVOT de-jailing of the RPA with Atlas-Balloon
28 Creation of a Y-stent Balloon expandable Y-Stent two 26mm Maxi stents, ev3
29 How to treat such a bifurcation? Matrix P valve, distal anastomosis stenosis
30 Creativity and Innovation in Pulmonary Artery Stenting pre-dilatation of the struts
31 Y-stent concept Implantation of a pulmonary valve
32 with a little help of our friends 71 yrs ROSS 4 yrs ago Endocarditis Re-PV replacement Feb. and Aug TV reconstr. März 2006 TV replacem. Dez actual: Pulmonary stenosis/-regurg. TV-regurgitation Transcatheter double valve replacement
33 RV function Procedure-Life-Balance 1.0 normal PR PS homograft Melody Courtesy M. Gewillig Age years
34 Transcatheter valve replacement Indications for pulmonary valve replacement Have the surgical and transcatheter replacement still the same indications? Free PR with progressive or moderate-severe RV dilatation, important TR, sustained atrial or ventricular arrhythmia or symptoms such as deteriorating exercise performance RVOTO with RV pressure 2/3 of systemic Mild to Moderate PS/PR leading to progressive RV dilatation, dysfunction or symptoms CCS Consensus: 2001 Update
35 Complications in Congenital Heart Diseases -with a little help of our friends Native valve, Conduit stenosis or leakage? How can the interventionalist help? P. Ewert German Heart Center Munich Lausanne 6/2015
36 Endokarditis-Risiko nach PPVI Multicenter Befragung AG Interventionen Sapien 11% 3245 Patientenjahre Melody 89% 2886 vs. 358
37 1,6 1,4 1,2 1 0,8 0,6 0,4 0,2 Endokarditis-Risiko nach PPVI Multicenter Befragung AG Interventionen n.s. Melody 2886 Sapien Melody Sapien Endokarditisinzidenz/Patientenjahr
38 Endokarditis-Risiko nach PPVI Pat Jahre Melody Pat. Jahre Sapien Endo/yr % Melody Endo/yr % Sapien 4,5 0,0 1,3 1,3 0,0 0,0 0,0 0,7 1,6 20,0 1,7 1,3 0,0 1,4 0,0 4,8 0,0 0,0 0,0 0,0 0,0 0,0 4,2 1,1 0,0 1,8 0,0 0,0
39 Endokarditis-Risiko nach PPVI Pat Jahre Melody Pat. Jahre Sapien Endo/yr % Melody Endo/yr % Sapien 4,5 0,0 1,3 1,3 0,0 0,0 0,0 0,7 1,6 20,0 1,7 1,3 0,0 1,4 0,0 4,8 0,0 0,0 0,0 0,0 0,0 0,0 4,2 1,1 0,0 1,8 0,0 0,0
40 Deutsches Herzzentrum München All Bioprosthetic Valves Are at Risk for BE Incidence (1 st yr) = 1-3% Incidence (1 st 5yrs) = 3-6% In der DGPK: 1,3% Alonso-Valle, JTCVS, Apr, 2010
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