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Catheter Cardiovasc Interv. 2017 Feb 1;89(2):298-305. doi: 10.1002/ccd.26648. Epub 2016 Jul 28.

Transcatheter valve implantation for right atrium-to-right ventricle conduit obstruction or regurgitation after modified Björk-fontan procedure.

Author information

1
Toronto General Hospital, Toronto, Canada.
2
German Heart Centre, Munich, Germany.
3
Yale University, New Haven, Connecticut.
4
University of Michigan, Ann Arbor, Michigan.
5
Necker Enfants Malades Hospital, Paris, France.
6
Mayo Clinic, Rochester, Minnesota.
7
University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee.
8
Deutsches Herzzentrum, Berlin, Germany.
9
University of California, San Francisco, California.
10
St. Paul's Hospital, Vancouver, Canada.
11
Stanford University, Palo Alto, California.

Abstract

BACKGROUND:

The most common reason for reintervention after a Björk modification of the Fontan procedure, in which the right ventricle (RV) is incorporated into the pulmonary circulation by connecting the right atrial (RA) appendage to the RV directly or with an extra-anatomic graft, is obstruction or regurgitation of the RA-RV connection. Transcatheter implantation of a valved stent is an appealing option for the treatment of RA-RV conduit dysfunction in these patients. In the present study, we assessed early and intermediate results after transcatheter valve implantation within an obstructed or regurgitant RA-RV modified Fontan pathway.

METHODS:

Through a retrospective multicenter registry, we collected data from 16 patients with a modified Fontan circulation who were treated with percutaneous Melody or Sapien valve implantation for dysfunction of an extra-anatomic RA-RV conduit or valve.

RESULTS:

All patients had successful and uncomplicated implantation of a Melody (n = 15) or Sapien 3 (n = 1) valve with hemodynamic and, in most cases, clinical improvement. During a median follow-up of 3.3 years, 3 patients died of cardiovascular causes unrelated to the procedure or the valve, and no major valve dysfunction was observed.

CONCLUSION:

Percutaneous transcatheter valve deployment to treat a dysfunctional RA-RV connection after a Björk modification of the Fontan procedure is a viable alternative to surgery, with low procedural risk, and appears to offer good early and intermediate results.© 2016 Wiley Periodicals, Inc.

KEYWORDS:

Fontan conversio; percutaneous valve replacement; total cavopulmonary connection; tricuspid valve replacement

PMID:
27465501
DOI:
10.1002/ccd.26648
[Indexed for MEDLINE]

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