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      Experiencia inicial con la nueva válvula pulmonar percutánea autoexpandible Venus P Translated title: Initial experience with the new percutaneous pulmonary self-expandable Venus P-valve

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          Abstract

          RESUMEN Introducción y objetivos: El implante percutáneo de válvula pulmonar es, actualmente, un procedimiento habitual en pacientes con cardiopatías congénitas con un tracto de salida del ventrículo derecho disfuncionante. Hasta abril de 2022, en Europa solo estaban disponibles las válvulas expandibles con balón, que no cubrían las necesidades de las distintas anatomías del tracto de salida derecho. Desde esa fecha está disponible la válvula autoexpandible Venus P (Venus MedTech, China). Presentamos la experiencia inicial en nuestro centro con esta nueva válvula pulmonar para implante percutáneo. Métodos: Descripción de los implantes valvulares con la nueva válvula autoexpandible realizados entre septiembre y noviembre de 2022. Resultados: Se han realizado 8 implantes valvulares, todos con éxito y sin complicaciones graves durante el procedimiento. Todos los pacientes presentaban insuficiencia pulmonar grave con repercusión sobre el ventrículo derecho y dilatación del tronco pulmonar, y no eran buenos candidatos para las válvulas expandibles con balón. Cinco pacientes tenían una tetralogía de Fallot de base. En 7 pacientes el implante se llevó a cabo por vía femoral y en 1 por vía yugular. Como medida de seguridad, en todos los pacientes el implante se hizo a través de una vaina DrySeal (Gore, W.L. Gore & Associates, Inc., Estados Unidos). La media de tiempo de ingreso fue de 3 días. Conclusiones: El implante de la nueva válvula autoexpandible Venus P fue, en nuestra experiencia preliminar, un procedimiento seguro y factible, que permite valvular tractos de salida derechos muy dilatados con contraindicación para las actuales válvulas expandibles con balón.

          Translated abstract

          ABSTRACT Introduction and objectives: Percutaneous pulmonary valve implantation is currently a common procedure in patients with congenital heart disease with a dysfunctional right ventricular outflow tract. Until April 2022, there were only balloon-expandable valves available in Europe, which did not cover the needs of the different anatomies of the right ventricular outflow tract. Since that date we have available the self-expandible Venus P-valve (Venus MedTech, China). We present the initial experience with this new percutaneous pulmonary valve in our center. Methods: Description of the valve implants with the new self-expandible valve performed between September and November 2022. Results: Eight valve implants have been performed, all successful and without severe complications during the procedure. All patients had severe pulmonary regurgitation with a dilated right ventricle and severe dilatation of the pulmonary trunk and were not good candidates for percutaneous balloon-expandable valves. Five patients had a tetralogy of Fallot. In 7 patients, the implant was performed through the femoral vein and in one through jugular access. As a safety measure, all valves were implanted through a DrySeal sheath (Gore, W.L. Gore & Associates, Inc., United States). The mean hospital stay was 3-day. Conclusions: Valve implantation with the new self-expandible Venus P-valve was, in our preliminary experience, a safe and feasible procedure, allowing us to treat very dilated right outflow tracts, not suitable for the current balloon-expandable valves.

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          Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction.

          Valved conduits from the right ventricle to the pulmonary artery are frequently used in paediatric cardiac surgery. However, stenosis and insufficiency of the conduit usually occur in the follow-up and lead to reoperations. Conduit stenting can delay surgical replacement, but it aggravates pulmonary insufficiency. We developed an innovative system for percutaneous stent implantation combined with valve replacement. A 12-year-old boy with stenosis and insufficiency of a prosthetic conduit from the right ventricle to the pulmonary artery underwent percutaneous implantation of a bovine jugular valve in the conduit. Angiography, haemodynamic assessment, and echocardiography after the procedure showed no insufficiency of the implanted valve, and partial relief of the conduit stenosis. There were no complications after 1 month of follow-up, and the patient is presently in good physical condition. We have shown that percutaneous valve replacement in the pulmonary position is possible. With further technical improvements, this new technique might also be used for valve replacement in other cardiac and non-cardiac positions.
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            Short- and medium-term outcomes after transcatheter pulmonary valve placement in the expanded multicenter US melody valve trial.

            Transcatheter pulmonary valve placement is an emerging therapy for pulmonary regurgitation and right ventricular outflow tract obstruction in selected patients. The Melody valve was recently approved in the United States for placement in dysfunctional right ventricular outflow tract conduits. From January 2007 to August 2009, 136 patients (median age, 19 years) underwent catheterization for intended Melody valve implantation at 5 centers. Implantation was attempted in 124 patients; in the other 12, transcatheter pulmonary valve placement was not attempted because of the risk of coronary artery compression (n=6) or other clinical or protocol contraindications. There was 1 death from intracranial hemorrhage after coronary artery dissection, and 1 valve was explanted after conduit rupture. The median peak right ventricular outflow tract gradient was 37 mm Hg before implantation and 12 mm Hg immediately after implantation. Before implantation, pulmonary regurgitation was moderate or severe in 92 patients (81% with data); no patient had more than mild pulmonary regurgitation early after implantation or during follow-up (>or=1 year in 65 patients). Freedom from diagnosis of stent fracture was 77.8+/-4.3% at 14 months. Freedom from Melody valve dysfunction or reintervention was 93.5+/-2.4% at 1 year. A higher right ventricular outflow tract gradient at discharge (P=0.003) and younger age (P=0.01) were associated with shorter freedom from dysfunction. In this updated report from the multicenter US Melody valve trial, we demonstrated an ongoing high rate of procedural success and encouraging short-term valve function. All reinterventions in this series were for right ventricular outflow tract obstruction, highlighting the importance of patient selection, adequate relief of obstruction, and measures to prevent and manage stent fracture. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00740870.
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              Medium-term results of percutaneous pulmonary valve implantation using the Venus P-valve: international experience.

              The aim of this study was to assess the international procedural and short-term to midterm experience with the new percutaneous Venus P-valve.
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                Author and article information

                Journal
                recic
                REC: Interventional Cardiology
                REC Interv Cardiol ES
                Sociedad Española de Cardiología (Madrid, Madrid, Spain )
                2604-7306
                2604-7276
                December 2023
                : 5
                : 4
                : 263-269
                Affiliations
                [1] Madrid orgnameHospital Universitario Ramón y Cajal orgdiv1Servicio de Cardiología Pediátrica y Cardiopatías Congénitas del Adulto España
                Article
                S2604-73062023000400005 S2604-7306(23)00500400005
                10.24875/recic.m23000373
                4b79397d-7893-4297-ad70-ff46a19325c2

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 03 January 2023
                : 15 February 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 11, Pages: 7
                Product

                SciELO Spain

                Categories
                Artículos originales

                Válvula pulmonar Venus P,Tetralogía de Fallot,Insuficiencia pulmonar,Válvula pulmonar,Cardiopatías congénitas,Percutaneous valve implantation,Venus P-valve,Tetralogy of Fallot,Pulmonary regurgitation,Pulmonary valve,Congenital heart disease,Implante percutáneo valvular

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