Editorial Percutaneous Pulmonary Valve Implantation Is Earlier Valve Implantation Better? Jamil Aboulhosn, MD; Daniel S. Levi, MD
I
n this issue of Circulation: Cardiovascular Interventions, Borik et al1 review the intermediate and long-term echocardiographic, MRI and cardiopulmonary exercise results in a cohort of 51 patients followed for a mean of 4.5±1.9 (0.9– 6.9) years after percutaneous pulmonary valve implantation (PPVI). The majority of patients had mixed pulmonary stenosis (PS) and pulmonary regurgitation (PR; 32/51) or predominant PS (16/51). The cohort is divided into patients 16 years. Clinical outcomes are favorable in the overall cohort, no differences were noted in the need for reintervention or reoperation between the younger and older groups and there was only one episode of endocarditis. Incremental improvements in right ventricular size by echo and MRI were noted in younger patients and there was a trend toward improvement in right ventricular ejection fraction in patients 16 years, had predominant PR. Therefore, one cannot conclude, from the data provided, that intervention at a younger age for predominant PR is associated with improved exercise and volumetric outcomes. However, the data provided by Borik et al1 does support the assertion that earlier intervention in patients with PS or mixed stenosis/regurgitation is associated with greater improvements in exercise capacity, RV size and RV function. Although the timing of RVOT intervention in asymptomatic patients is mostly predicated on the presence of RVOT
Downloaded from http://circinterventions.ahajournals.org/ at McMaster University Library on July 2, 2015 1
2 Aboulhosn and Levi Is Earlier Pulmonary Valve Implantation Better dysfunction, enlarged RV size, and RV systolic dysfunction, other considerations should also be taken into account. Placement of a transcatheter pulmonary valve may improve conduit or bioprosthetic valve stenosis and regurgitation; however, this does come at a cost. The effective maximum internal circumference of the conduit or bioprosthesis is inevitably decreased after valve placement. Lurz et al12 demonstrated excellent long-term survival post Melody pulmonary valve replacement; however, 27% of patients did require reintervention at 70 months of follow-up, the highest risk for reintervention was in those with residual RVOT gradient >25 mm Hg and in the first 50 cases performed. It would stand to reason that percutaneous pulmonary valve function, as is the case with surgically placed bioprosthetic valves or conduits, will deteriorate over time and that replacement will be needed in the majority of patients within 1 to 2 decades. For example, a child with a dysfunctional 18-mm homograft that undergoes Melody valve placement at 10 years of age may require at last 3 future valve replacements during the next 60 years of life. Thus, one would expect the gradual development of worsening conduit stenosis with multiple PPVI procedures and eventual need for surgical conduit revision. The long-term consequences of multiple surgical RVOT interventions include ventricular diastolic dysfunction and a significant increase in atrial and ventricular arrhythmias, sudden cardiac death, and need for defibrillator placement.13,14 Therefore, when taking the long view on percutaneous pulmonary valve replacement, it is imperative to consider the size of the existing RVOT, the potential need for subsequent reintervention and the resultant eventual and inevitable stenosis of the existing RV to PA communication. The risk of infective endocarditis in patients that have undergone Melody valve placement must also be considered. Although only one patient in this cohort (2%) had infective endocarditis, infective endocarditis has been shown to occur with an estimated annualized rate as high as 2.4% per patient year.15,16 Is earlier PPVI better? It depends. If the patient is symptomatic or has decreased functional capacity then intervention is certainly indicated. If the patient has significant RVOT stenosis or mixed PS/PR then one would expect improvement in exercise capacity with intervention. Patients with predominant PR may also benefit but there is little data to suggest early intervention is associated with improved clinical or functional outcomes in those with normal functional capacity (New York Heart Association class I). The existing data supports intervention at certain volumetric thresholds or in those with reduced right ventricular ejection fraction to normalize RV volume and improve systolic function but not to reduce hard clinical end points. This article demonstrates that early valve placement in younger patients with predominant PS or mixed PS/ PR is associated with improved exercise and volumetric outcomes but, similar to previous studies, does not demonstrate improved clinical outcomes. The long-term impact of early PPVI and the need for subsequent valve in valve implants with eventual luminal stenosis should also be considered. This may not be as important of a consideration in patients with native RVOTs or patches where there is no absolute size limitation imposed by a surgically placed conduit or bioprosthetic valve. As there may be significant benefits to earlier PPVI,
this article provides more impetus for a well-controlled study of the long-term benefits of earlier PPVI. However, because early PPVI also has risks and disadvantages, these interventions must be carefully planned and studied. Are we starting to see a paradigm shift toward earlier PPVI? Because Melody PPVI has been shown to be safe and effective with excellent short- and intermediate-term outcomes and favorable risk profile,12,17,18 we have seen congenital cardiologists sending patients earlier for PPVI than they did for surgical pulmonary valve implantation. Is earlier pulmonary valve replacement justified now that this procedure can be done in a transcatheter fashion? It is impossible to make definitive recommendations based on the data from this article by Borik et al1: this retrospective data includes a mixed population of patients with PS/PR with only 23 patients 16 years of age, and with data available on only a fraction of these patients and no control subjects. Nonetheless, the authors clearly show that younger patients may benefit from earlier PPVI and it is reasonable to continue to study the effects of lowering the bar for PPVI.
Disclosures None.
References 1. Borik S, Crean A, Horlick E, Osten M, Lee K-J, Chaturvedi R, Friedberg MK, McCrindle BW, Manlhiot C, Benson L. Percutaneous pulmonary valve implantation: 5 years of follow-up: does age influence outcomes? Circ Cardiovasc Interv. 2015;8:e001745 doi: 10.1161/ CIRCINTERVENTIONS.114.001745. 2. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP Jr, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/ AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008;118:e714–e833. 3. Coats L, Khambadkone S, Derrick G, Sridharan S, Schievano S, Mist B, Jones R, Deanfield JE, Pellerin D, Bonhoeffer P, Taylor AM. Physiological and clinical consequences of relief of right ventricular outflow tract obstruction late after repair of congenital heart defects. Circulation. 2006;113:2037–2044. doi: 10.1161/CIRCULATIONAHA.105.591438. 4. Lurz P, Nordmeyer J, Giardini A, Khambadkone S, Muthurangu V, Schievano S, Thambo JB, Walker F, Cullen S, Derrick G, Taylor AM, Bonhoeffer P. Early versus late functional outcome after successful percutaneous pulmonary valve implantation: are the acute effects of altered right ventricular loading all we can expect? J Am Coll Cardiol. 2011;57:724–731. doi: 10.1016/j.jacc.2010.07.056. 5. Batra AS, McElhinney DB, Wang W, Zakheim R, Garofano RP, Daniels C, Yung D, Cooper DM, Rhodes J. Cardiopulmonary exercise function among patients undergoing transcatheter pulmonary valve implantation in the US Melody valve investigational trial. Am Heart J. 2012;163:280–287. doi: 10.1016/j.ahj.2011.10.017. 6. Frigiola A, Tsang V, Bull C, Coats L, Khambadkone S, Derrick G, Mist B, Walker F, van Doorn C, Bonhoeffer P, Taylor AM. Biventricular response after pulmonary valve replacement for right ventricular outflow tract dysfunction: is age a predictor of outcome? Circulation. 2008;118(suppl 14):S182–S190. doi: 10.1161/CIRCULATIONAHA.107.756825. 7. Therrien J, Siu SC, McLaughlin PR, Liu PP, Williams WG, Webb GD. Pulmonary valve replacement in adults late after repair of tetralogy of Fallot: are we operating too late? J Am Coll Cardiol. 2000;36:1670–1675. 8. Lee C, Kim YM, Lee CH, Kwak JG, Park CS, Song JY, Shim WS, Choi EY, Lee SY, Baek JS. Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement. J Am Coll Cardiol. 2012;60:1005–1014. doi: 10.1016/j.jacc.2012.03.077.
Downloaded from http://circinterventions.ahajournals.org/ at McMaster University Library on July 2, 2015
3 Aboulhosn and Levi Is Earlier Pulmonary Valve Implantation Better 9. Oosterhof T, van Straten A, Vliegen HW, Meijboom FJ, van Dijk AP, Spijkerboer AM, Bouma BJ, Zwinderman AH, Hazekamp MG, de Roos A, Mulder BJ. Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation. 2007;116:545–551. doi: 10.1161/ CIRCULATIONAHA.106.659664. 10. Knauth AL, Gauvreau K, Powell AJ, Landzberg MJ, Walsh EP, Lock JE, del Nido PJ, Geva T. Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart. 2008;94:211–216. doi: 10.1136/hrt.2006.104745. 11. Ferraz Cavalcanti PE, Sá MP, Santos CA, Esmeraldo IM, de Escobar RR, de Menezes AM, de Azevedo OM Jr, de Vasconcelos Silva FP, Lins RF, Lima Rde C. Pulmonary valve replacement after operative repair of tetralogy of Fallot: meta-analysis and meta-regression of 3,118 patients from 48 studies. J Am Coll Cardiol. 2013;62:2227–2243. doi: 10.1016/j. jacc.2013.04.107. 12. Lurz P, Coats L, Khambadkone S, Nordmeyer J, Boudjemline Y, Schievano S, Muthurangu V, Lee TY, Parenzan G, Derrick G, Cullen S, Walker F, Tsang V, Deanfield J, Taylor AM, Bonhoeffer P. Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome. Circulation. 2008;117:1964–1972. doi: 10.1161/ CIRCULATIONAHA.107.735779. 13. Aboulhosn JA, Lluri G, Gurvitz MZ, Khairy P, Mongeon FP, Kay J, Valente AM, Earing MG, Opotowsky AR, Lui G, Gersony DR, Cook S, Child J, Ting J, Webb G, Landzberg M, Broberg CS; Alliance for Adult Research in Congenital Cardiology (AARCC). Left and right ventricular diastolic function in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Can J Cardiol. 2013;29:866–872. doi: 10.1016/j.cjca.2012.11.003. 14. Khairy P, Aboulhosn J, Gurvitz MZ, Opotowsky AR, Mongeon FP, Kay J, Valente AM, Earing MG, Lui G, Gersony DR, Cook S, Ting JG, Nickolaus
MJ, Webb G, Landzberg MJ, Broberg CS; Alliance for Adult Research in Congenital Cardiology (AARCC). Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Circulation. 2010;122:868–875. doi: 10.1161/CIRCULATIONAHA.109.928481. 15. Buber J, Bergersen L, Lock JE, Gauvreau K, Esch JJ, Landzberg MJ, Valente AM, Sandora TJ, Marshall AC. Bloodstream infections occurring in patients with percutaneously implanted bioprosthetic pulmonary valve: a single-center experience. Circ Cardiovasc Interv. 2013;6:301–310. doi: 10.1161/CIRCINTERVENTIONS.112.000348. 16. McElhinney DB, Benson LN, Eicken A, Kreutzer J, Padera RF, Zahn EM. Infective endocarditis after transcatheter pulmonary valve replacement using the Melody valve: combined results of 3 prospective North American and European studies. Circ Cardiovasc Interv. 2013;6:292–300. doi: 10.1161/CIRCINTERVENTIONS.112.000087. 17. Butera G, Milanesi O, Spadoni I, Piazza L, Donti A, Ricci C, Agnoletti G, Pangrazi A, Chessa M, Carminati M. Melody transcatheter pulmonary valve implantation. Results from the registry of the Italian Society of Pediatric Cardiology. Catheter Cardiovasc Interv. 2013;81:310–316. doi: 10.1002/ccd.24518. 18. McElhinney DB, Cheatham JP, Jones TK, Lock JE, Vincent JA, Zahn EM, Hellenbrand WE. Stent fracture, valve dysfunction, and right ventricular outflow tract reintervention after transcatheter pulmonary valve implantation: patient-related and procedural risk factors in the US Melody Valve Trial. Circ Cardiovasc Interv. 2011;4:602–614. doi: 10.1161/ CIRCINTERVENTIONS.111.965616. Key Words: Editorials ◼ congenital heart disease and skeletal malformations ◼ pulmonary circulation ◼ pulmonary valve ◼ tetralogy of Fallot ◼ transcatheter pulmonary valve replacement
Downloaded from http://circinterventions.ahajournals.org/ at McMaster University Library on July 2, 2015
Percutaneous Pulmonary Valve Implantation: Is Earlier Valve Implantation Better? Jamil Aboulhosn and Daniel S. Levi Circ Cardiovasc Interv. 2015;8: doi: 10.1161/CIRCINTERVENTIONS.115.002260 Circulation: Cardiovascular Interventions is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2015 American Heart Association, Inc. All rights reserved. Print ISSN: 1941-7640. Online ISSN: 1941-7632
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circinterventions.ahajournals.org/content/8/2/e002260
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation: Cardiovascular Interventions can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation: Cardiovascular Interventions is online at: http://circinterventions.ahajournals.org//subscriptions/
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I
n this issue of Circulation: Cardiovascular Interventions, Borik et al1 review the intermediate and long-term echocardiographic, MRI and cardiopulmonary exercise results in a cohort of 51 patients followed for a mean of 4.5±1.9 (0.9– 6.9) years after percutaneous pulmonary valve implantation (PPVI). The majority of patients had mixed pulmonary stenosis (PS) and pulmonary regurgitation (PR; 32/51) or predominant PS (16/51). The cohort is divided into patients 16 years. Clinical outcomes are favorable in the overall cohort, no differences were noted in the need for reintervention or reoperation between the younger and older groups and there was only one episode of endocarditis. Incremental improvements in right ventricular size by echo and MRI were noted in younger patients and there was a trend toward improvement in right ventricular ejection fraction in patients 16 years, had predominant PR. Therefore, one cannot conclude, from the data provided, that intervention at a younger age for predominant PR is associated with improved exercise and volumetric outcomes. However, the data provided by Borik et al1 does support the assertion that earlier intervention in patients with PS or mixed stenosis/regurgitation is associated with greater improvements in exercise capacity, RV size and RV function. Although the timing of RVOT intervention in asymptomatic patients is mostly predicated on the presence of RVOT
Downloaded from http://circinterventions.ahajournals.org/ at McMaster University Library on July 2, 2015 1
2 Aboulhosn and Levi Is Earlier Pulmonary Valve Implantation Better dysfunction, enlarged RV size, and RV systolic dysfunction, other considerations should also be taken into account. Placement of a transcatheter pulmonary valve may improve conduit or bioprosthetic valve stenosis and regurgitation; however, this does come at a cost. The effective maximum internal circumference of the conduit or bioprosthesis is inevitably decreased after valve placement. Lurz et al12 demonstrated excellent long-term survival post Melody pulmonary valve replacement; however, 27% of patients did require reintervention at 70 months of follow-up, the highest risk for reintervention was in those with residual RVOT gradient >25 mm Hg and in the first 50 cases performed. It would stand to reason that percutaneous pulmonary valve function, as is the case with surgically placed bioprosthetic valves or conduits, will deteriorate over time and that replacement will be needed in the majority of patients within 1 to 2 decades. For example, a child with a dysfunctional 18-mm homograft that undergoes Melody valve placement at 10 years of age may require at last 3 future valve replacements during the next 60 years of life. Thus, one would expect the gradual development of worsening conduit stenosis with multiple PPVI procedures and eventual need for surgical conduit revision. The long-term consequences of multiple surgical RVOT interventions include ventricular diastolic dysfunction and a significant increase in atrial and ventricular arrhythmias, sudden cardiac death, and need for defibrillator placement.13,14 Therefore, when taking the long view on percutaneous pulmonary valve replacement, it is imperative to consider the size of the existing RVOT, the potential need for subsequent reintervention and the resultant eventual and inevitable stenosis of the existing RV to PA communication. The risk of infective endocarditis in patients that have undergone Melody valve placement must also be considered. Although only one patient in this cohort (2%) had infective endocarditis, infective endocarditis has been shown to occur with an estimated annualized rate as high as 2.4% per patient year.15,16 Is earlier PPVI better? It depends. If the patient is symptomatic or has decreased functional capacity then intervention is certainly indicated. If the patient has significant RVOT stenosis or mixed PS/PR then one would expect improvement in exercise capacity with intervention. Patients with predominant PR may also benefit but there is little data to suggest early intervention is associated with improved clinical or functional outcomes in those with normal functional capacity (New York Heart Association class I). The existing data supports intervention at certain volumetric thresholds or in those with reduced right ventricular ejection fraction to normalize RV volume and improve systolic function but not to reduce hard clinical end points. This article demonstrates that early valve placement in younger patients with predominant PS or mixed PS/ PR is associated with improved exercise and volumetric outcomes but, similar to previous studies, does not demonstrate improved clinical outcomes. The long-term impact of early PPVI and the need for subsequent valve in valve implants with eventual luminal stenosis should also be considered. This may not be as important of a consideration in patients with native RVOTs or patches where there is no absolute size limitation imposed by a surgically placed conduit or bioprosthetic valve. As there may be significant benefits to earlier PPVI,
this article provides more impetus for a well-controlled study of the long-term benefits of earlier PPVI. However, because early PPVI also has risks and disadvantages, these interventions must be carefully planned and studied. Are we starting to see a paradigm shift toward earlier PPVI? Because Melody PPVI has been shown to be safe and effective with excellent short- and intermediate-term outcomes and favorable risk profile,12,17,18 we have seen congenital cardiologists sending patients earlier for PPVI than they did for surgical pulmonary valve implantation. Is earlier pulmonary valve replacement justified now that this procedure can be done in a transcatheter fashion? It is impossible to make definitive recommendations based on the data from this article by Borik et al1: this retrospective data includes a mixed population of patients with PS/PR with only 23 patients 16 years of age, and with data available on only a fraction of these patients and no control subjects. Nonetheless, the authors clearly show that younger patients may benefit from earlier PPVI and it is reasonable to continue to study the effects of lowering the bar for PPVI.
Disclosures None.
References 1. Borik S, Crean A, Horlick E, Osten M, Lee K-J, Chaturvedi R, Friedberg MK, McCrindle BW, Manlhiot C, Benson L. Percutaneous pulmonary valve implantation: 5 years of follow-up: does age influence outcomes? Circ Cardiovasc Interv. 2015;8:e001745 doi: 10.1161/ CIRCINTERVENTIONS.114.001745. 2. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP Jr, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/ AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008;118:e714–e833. 3. Coats L, Khambadkone S, Derrick G, Sridharan S, Schievano S, Mist B, Jones R, Deanfield JE, Pellerin D, Bonhoeffer P, Taylor AM. Physiological and clinical consequences of relief of right ventricular outflow tract obstruction late after repair of congenital heart defects. Circulation. 2006;113:2037–2044. doi: 10.1161/CIRCULATIONAHA.105.591438. 4. Lurz P, Nordmeyer J, Giardini A, Khambadkone S, Muthurangu V, Schievano S, Thambo JB, Walker F, Cullen S, Derrick G, Taylor AM, Bonhoeffer P. Early versus late functional outcome after successful percutaneous pulmonary valve implantation: are the acute effects of altered right ventricular loading all we can expect? J Am Coll Cardiol. 2011;57:724–731. doi: 10.1016/j.jacc.2010.07.056. 5. Batra AS, McElhinney DB, Wang W, Zakheim R, Garofano RP, Daniels C, Yung D, Cooper DM, Rhodes J. Cardiopulmonary exercise function among patients undergoing transcatheter pulmonary valve implantation in the US Melody valve investigational trial. Am Heart J. 2012;163:280–287. doi: 10.1016/j.ahj.2011.10.017. 6. Frigiola A, Tsang V, Bull C, Coats L, Khambadkone S, Derrick G, Mist B, Walker F, van Doorn C, Bonhoeffer P, Taylor AM. Biventricular response after pulmonary valve replacement for right ventricular outflow tract dysfunction: is age a predictor of outcome? Circulation. 2008;118(suppl 14):S182–S190. doi: 10.1161/CIRCULATIONAHA.107.756825. 7. Therrien J, Siu SC, McLaughlin PR, Liu PP, Williams WG, Webb GD. Pulmonary valve replacement in adults late after repair of tetralogy of Fallot: are we operating too late? J Am Coll Cardiol. 2000;36:1670–1675. 8. Lee C, Kim YM, Lee CH, Kwak JG, Park CS, Song JY, Shim WS, Choi EY, Lee SY, Baek JS. Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement. J Am Coll Cardiol. 2012;60:1005–1014. doi: 10.1016/j.jacc.2012.03.077.
Downloaded from http://circinterventions.ahajournals.org/ at McMaster University Library on July 2, 2015
3 Aboulhosn and Levi Is Earlier Pulmonary Valve Implantation Better 9. Oosterhof T, van Straten A, Vliegen HW, Meijboom FJ, van Dijk AP, Spijkerboer AM, Bouma BJ, Zwinderman AH, Hazekamp MG, de Roos A, Mulder BJ. Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation. 2007;116:545–551. doi: 10.1161/ CIRCULATIONAHA.106.659664. 10. Knauth AL, Gauvreau K, Powell AJ, Landzberg MJ, Walsh EP, Lock JE, del Nido PJ, Geva T. Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart. 2008;94:211–216. doi: 10.1136/hrt.2006.104745. 11. Ferraz Cavalcanti PE, Sá MP, Santos CA, Esmeraldo IM, de Escobar RR, de Menezes AM, de Azevedo OM Jr, de Vasconcelos Silva FP, Lins RF, Lima Rde C. Pulmonary valve replacement after operative repair of tetralogy of Fallot: meta-analysis and meta-regression of 3,118 patients from 48 studies. J Am Coll Cardiol. 2013;62:2227–2243. doi: 10.1016/j. jacc.2013.04.107. 12. Lurz P, Coats L, Khambadkone S, Nordmeyer J, Boudjemline Y, Schievano S, Muthurangu V, Lee TY, Parenzan G, Derrick G, Cullen S, Walker F, Tsang V, Deanfield J, Taylor AM, Bonhoeffer P. Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome. Circulation. 2008;117:1964–1972. doi: 10.1161/ CIRCULATIONAHA.107.735779. 13. Aboulhosn JA, Lluri G, Gurvitz MZ, Khairy P, Mongeon FP, Kay J, Valente AM, Earing MG, Opotowsky AR, Lui G, Gersony DR, Cook S, Child J, Ting J, Webb G, Landzberg M, Broberg CS; Alliance for Adult Research in Congenital Cardiology (AARCC). Left and right ventricular diastolic function in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Can J Cardiol. 2013;29:866–872. doi: 10.1016/j.cjca.2012.11.003. 14. Khairy P, Aboulhosn J, Gurvitz MZ, Opotowsky AR, Mongeon FP, Kay J, Valente AM, Earing MG, Lui G, Gersony DR, Cook S, Ting JG, Nickolaus
MJ, Webb G, Landzberg MJ, Broberg CS; Alliance for Adult Research in Congenital Cardiology (AARCC). Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Circulation. 2010;122:868–875. doi: 10.1161/CIRCULATIONAHA.109.928481. 15. Buber J, Bergersen L, Lock JE, Gauvreau K, Esch JJ, Landzberg MJ, Valente AM, Sandora TJ, Marshall AC. Bloodstream infections occurring in patients with percutaneously implanted bioprosthetic pulmonary valve: a single-center experience. Circ Cardiovasc Interv. 2013;6:301–310. doi: 10.1161/CIRCINTERVENTIONS.112.000348. 16. McElhinney DB, Benson LN, Eicken A, Kreutzer J, Padera RF, Zahn EM. Infective endocarditis after transcatheter pulmonary valve replacement using the Melody valve: combined results of 3 prospective North American and European studies. Circ Cardiovasc Interv. 2013;6:292–300. doi: 10.1161/CIRCINTERVENTIONS.112.000087. 17. Butera G, Milanesi O, Spadoni I, Piazza L, Donti A, Ricci C, Agnoletti G, Pangrazi A, Chessa M, Carminati M. Melody transcatheter pulmonary valve implantation. Results from the registry of the Italian Society of Pediatric Cardiology. Catheter Cardiovasc Interv. 2013;81:310–316. doi: 10.1002/ccd.24518. 18. McElhinney DB, Cheatham JP, Jones TK, Lock JE, Vincent JA, Zahn EM, Hellenbrand WE. Stent fracture, valve dysfunction, and right ventricular outflow tract reintervention after transcatheter pulmonary valve implantation: patient-related and procedural risk factors in the US Melody Valve Trial. Circ Cardiovasc Interv. 2011;4:602–614. doi: 10.1161/ CIRCINTERVENTIONS.111.965616. Key Words: Editorials ◼ congenital heart disease and skeletal malformations ◼ pulmonary circulation ◼ pulmonary valve ◼ tetralogy of Fallot ◼ transcatheter pulmonary valve replacement
Downloaded from http://circinterventions.ahajournals.org/ at McMaster University Library on July 2, 2015
Percutaneous Pulmonary Valve Implantation: Is Earlier Valve Implantation Better? Jamil Aboulhosn and Daniel S. Levi Circ Cardiovasc Interv. 2015;8: doi: 10.1161/CIRCINTERVENTIONS.115.002260 Circulation: Cardiovascular Interventions is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2015 American Heart Association, Inc. All rights reserved. Print ISSN: 1941-7640. Online ISSN: 1941-7632
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circinterventions.ahajournals.org/content/8/2/e002260
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation: Cardiovascular Interventions can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation: Cardiovascular Interventions is online at: http://circinterventions.ahajournals.org//subscriptions/
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