Percutaneous balloon dilation of Carpentier-Edwards porcine-valved right ventricle-to-pulmonary artery conduits

Pediatr Cardiol. 2013 Apr;34(4):978-83. doi: 10.1007/s00246-012-0591-2. Epub 2012 Dec 11.

Abstract

Right ventricular outflow tract (RVOT) conduit stenosis remains a significant problem for patients with right ventricle-to-pulmonary artery (RV-to-PA) conduits placed as palliation for congenital heart disease. Previous reports on balloon dilation of RVOT conduits all describe small series with varying levels of success during limited follow-up evaluation. This study reviewed all patients with RV-to-PA conduits who underwent percutaneous balloon dilation for conduit stenosis at the authors' institution from 2000 to 2011. Patients with Carpentier-Edwards (CE) model 4300 porcine-valved conduits (Edwards Lifesciences Corp., Irvine, CA) (n = 19) were compared with patients who had all other types of conduits (n = 19). Successful balloon angioplasty was defined as a 20 % decrease in the RV-to-PA gradient, a 20 % decrease in the ratio of the RV systolic-to-aortic systolic pressure, or both. Balloon dilation was successful for 57.9 % of the patients with CE conduits and for 31.6 % of patients with other types of conduits (p = 0.10, Chi square test). Logistic regression analysis showed that balloon dilation was significantly more likely to be successful with CE valves than with other types (odds ratio [OR], 6.59; 95 % confidence interval [CI], 1.22-35.49). In a continuous series of patients with stenotic RV-to-PA conduits, the CE porcine-valved conduit was more amenable to percutaneous balloon dilation than other types of RV-to-PA conduits at the midterm follow-up evaluation. This has important ramifications in terms of valve selection for patients with congenital heart disease who will require surgical reintervention for RVOT stenosis.

MeSH terms

  • Adolescent
  • Angioplasty, Balloon, Coronary*
  • Animals
  • Bioprosthesis*
  • Blood Vessel Prosthesis*
  • Cardiac Catheterization
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Female
  • Graft Occlusion, Vascular / surgery*
  • Heart Defects, Congenital / surgery*
  • Heart Ventricles / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Logistic Models
  • Male
  • Pulmonary Artery / surgery*
  • Retrospective Studies
  • Swine
  • Ventricular Outflow Obstruction / surgery*