Early multicenter experience of a new balloon expandable MyVal transcatheter heart valve in dysfunctional stenosed right ventricular outflow tract conduits

Muthukumaran C Sivaprakasam; J Raja Vijendra Reddy; Sengottuvelu Gunasekaran; Kothandam Sivakumar; Sreeja Pavithran; Gopalavilasam Rajagopalan Rohitraj; M Jayranganath; Edwin Francis

doi:10.4103/apc.apc_242_20

Early multicenter experience of a new balloon expandable MyVal transcatheter heart valve in dysfunctional stenosed right ventricular outflow tract conduits

Ann Pediatr Cardiol. 2021 Jul-Sep;14(3):293-301. doi: 10.4103/apc.apc_242_20. Epub 2021 Aug 26.

Authors

Muthukumaran C Sivaprakasam¹, J Raja Vijendra Reddy¹, Sengottuvelu Gunasekaran¹, Kothandam Sivakumar², Sreeja Pavithran², Gopalavilasam Rajagopalan Rohitraj², M Jayranganath³, Edwin Francis⁴

Affiliations

¹ Department of Pediatric Cardiology, Apollo Children's Hospital, Chennai, Tamil Nadu, India.
² Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India.
³ Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research Institute, Bengaluru, Karnataka, India.
⁴ Department of Pediatric Cardiology, Lisie Hospital, Kochi, Kerala, India.

Abstract

Background: Transcatheter pulmonary valve implantation (TPVI) is a surgical alternative for correcting dysfunctional right ventricular outflow tract conduits in previously operated patients. MyVal transcatheter heart valve (THV) (Meril Life Sciences, India), a new transcatheter valve designed for aortic position has not been used for TPVI.

Methods: Patients with stenosed dysfunctional conduits from the right ventricle to pulmonary artery (RV-PA) were prestented after initial computed tomography and balloon interrogation before the implantation of MyVal. Size of MyVal was chosen based on the final diameter of the prestent. Procedural details and post-TPVI follow-up were analyzed.

Results: Seven patients aged 17-60 years (median 26 years) had stenosed RV-PA conduits implanted 5-17 years (median 9 years) ago for tetralogy of Fallot in three, following Ross procedure in two, repair of pulmonary stenosis, and following PA debanding in one patient each. Prestenting improved the conduit diameter from 9.3 ± 2.8 mm to 20.8 ± 1.1 mm and relieved the gradient from 87.3 ± 31.7 mmHg (50-137 mmHg) to 12.7 ± 6.4 mmHg (5-20 mmHg). A 23 mm MyVal was implanted in all the seven patients successfully; one patient needed an additional 24.5 mm MyVal valve in valve implantation for residual regurgitation. The mean fluoroscopic time and dose area product were 38.7 ± 25.3 min and 66.917 ± 39.211Gray. cm2, respectively. At a median follow-up duration of 16 months (10-22 months), all patients were asymptomatic receiving dual antiplatelet therapy with no PR and the gradient was 12.5 ± 5.8 mmHg on echocardiography. Although one patient needed an additional valve-in-valve implantation, there were no valve-related adverse events.

Conclusions: Early experience of TPVI with MyVal THV in prestented conduits is encouraging with procedural success in all patients and acceptable mid-term outcomes.

Keywords: Congenital heart disease; Pulmonary regurgitation; Right ventricular conduit; Transcatheter pulmonary valve.