Outcomes of Venus P-valve for dysfunctional right ventricular outflow tracts from Indian Venus P-valve database

Kothandam Sivakumar; Pramod Sagar; Shakeel Qureshi; Worakan Promphan; Bijulal Sasidharan; Neeraj Awasthy; Mahesh Kappanayil; Pujar Venkatesh Suresh; Nageswara Rao Koneti

doi:10.4103/apc.APC_175_20

Outcomes of Venus P-valve for dysfunctional right ventricular outflow tracts from Indian Venus P-valve database

Ann Pediatr Cardiol. 2021 Jul-Sep;14(3):281-292. doi: 10.4103/apc.APC_175_20. Epub 2021 Aug 26.

Authors

Kothandam Sivakumar¹, Pramod Sagar¹, Shakeel Qureshi², Worakan Promphan³, Bijulal Sasidharan⁴, Neeraj Awasthy⁵, Mahesh Kappanayil⁶, Pujar Venkatesh Suresh⁷, Nageswara Rao Koneti⁸

Affiliations

¹ Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India.
² Department of Pediatric Cardiology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS, London, UK.
³ Department of Pediatric Cardiology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
⁴ Department of Pediatric Cardiology, Sree Chitra Tirunal Institute, Thiruvananthapuram, Kerala, India.
⁵ Department of Pediatric Cardiology, Max Super Specialty Hospital, Delhi, India.
⁶ Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
⁷ Department of Pediatric Cardiology, Narayana Hrudayalaya, Bengaluru, Karnataka, India.
⁸ Department of Pediatric Cardiology,Care Hospital, Hyderabad, Telangana, India.

Abstract

Background: Balloon-expandable pulmonary valves are usually not suitable for dilated native outflow tracts.

Methods: Indian Venus P-valve registry was retrospectively analyzed for efficacy, complications, and midterm outcomes. Straight valve was used in prestented conduits in patients with right ventricular pressure above two-thirds systemic pressure and/or right ventricular dysfunction. Flared valve 1-4 mm larger than balloon waist was used in native outflow in symptomatic patients, large ventricular volumes, and ventricular dysfunction.

Objectives: A self-expanding porcine pericardial Venus P-valve is available in straight and flared designs..

Results: Twenty-nine patients were included. Straight valve was successful in all seven conduits, reducing gradients significantly, including one patient with left pulmonary artery (LPA) stent. Flared valve was successfully implanted in 20 out of 22 native outflow tracts. Sharp edges of the older design contributed to two failures. Complications included two migrations with one needing surgery, endocarditis in one, insignificant wire-frame fractures in three, and groin vascular complication in one patient. There were no deaths or valve-related reinterventions at a mean follow-up of 47.8 ± 24.5 months (1-85 months). Modifications of technique succeeded in three patients with narrow LPA. There was significant improvement in symptoms, right ventricular volume, and pulmonary regurgitant fraction.

Conclusion: Straight and flared Venus P-valves are safe and effective in appropriate outflow tracts. Straight valve is an alternative to balloon-expandable valves in stenosed conduits. Flared valve is suitable for large outflows up to 34 mm, including patients with LPA stenosis. Recent design modifications may correct previous technical failures. Studies should focus on durability and late complications.

Keywords: Balloon sizing; infective endocarditis; left pulmonary artery stenosis; percutaneous pulmonary valve implantation; self-expanding valve; valve migration.