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Transcatheter valve implantation for right atrium‐to‐right ventricle conduit obstruction or regurgitation after modified Björk–fontan procedure
Author(s) -
Shah Ashish H.,
Horlick Eric M.,
Eicken Andreas,
Asnes Jeremy D.,
Bocks Martin L.,
Boudjemline Younes,
Cabalka Allison K.,
Fagan Thomas E.,
Schubert Stephan,
Mahadevan Vaikom S.,
Dvir Danny,
Osten Mark,
McElhinney Doff B.
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26648
Subject(s) - medicine , cardiology , ventricle , regurgitation (circulation) , surgery , percutaneous , pulmonary valve , fontan procedure
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.