Harmony Transcatheter Pulmonary Valve implantation in an Ovine Model: a novel percutaneous strategy for pulmonary valve replacement after Tetralogy of Fallot Repair

Schoonbeek, R.C. (Rosanne) (2016) Harmony Transcatheter Pulmonary Valve implantation in an Ovine Model: a novel percutaneous strategy for pulmonary valve replacement after Tetralogy of Fallot Repair. thesis, Medicine.

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Abstract

Background – Pulmonary insufficiency (PI) and consequent right ventricular outflow tract (RVOT) dilatation are frequently encountered complications after transannular patch (TAP) repair of Tetralogy of Fallot (ToF). The adverse remodeling of the RVOT after longstanding PI is a common indication for surgical pulmonary valve replacement (PVR). This study aimed to establish the feasibility of implantation of the novel Medtronic Harmony Transcatheter Pulmonary Valve (hTPV), and to assess its effect on PI and ventricular function in an ovine model of chronic PI. Methods – Thirteen sheep underwent baseline cardiac 4-dimensional flow (4DF) MRI, surgical pulmonary valvectomy and TAP. One month following TAP, the hTPV was implanted, followed by serial MRI and CT imaging at 1, 5 and 8 month(s). Results – hTPV implantation was successful in 11 animals (85%). There were two procedural deaths related to ventricular fibrillation. Seven animals survived the entire follow-up protocol; five with functioning hTPV devices. Two animals had occlusion of hTPV with aneurysm of main pulmonary artery (MPA). A strong decline in pulmonary regurgitant fraction (PRF) was observed after hTPV implantation (40.5% versus 8.3%, p = 0.011). RV end-diastolic volume increased by 49.4% after TAP (62.3 to 93.1 ml/m2, p = 0.028), but reverse remodeled back to baseline values after hTPV implantation (to 65.1 ml/m2 at 8 months, p = 0.045). Both right ventricular (RV) ejection fraction (EF) and left ventricular (LV) EF were preserved after hTPV implantation. Conclusions – hTPV implantation is feasible, significantly reduces PRF, facilitates RV remodeling, normalized diastolic flow patterns and preserves biventricular function in an ovine model of chronic postoperative PI. This transcatheter strategy offers an alternative for standard surgical PVR in dilated and over-sized RVOTs, permitting lower risk, non-surgical valve replacement in previously prohibitive anatomies

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty Supervisor and Kallenberg, Prof. dr. C.G.M.
Supervisor name:	External Supervisor and Gillespie, Prof. dr. M.J. and Institution Gorman Cardiovascular Research Group, Department and Division of Cardiology, The Children’s Hospital of Philadelp and University of Pennsylvania School of Medicine, Philadelphia
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:54
Last Modified:	25 Jun 2020 10:54
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1497

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