Valve Frame Geometry and Arrhythmia Risk Following Self-Expanding Transcatheter Pulmonary Valve Replacement. - National Genomics Data Center (CNCB-NGDC)

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Valve Frame Geometry and Arrhythmia Risk Following Self-Expanding Transcatheter Pulmonary Valve Replacement.

Natalie Soszyn, Gabriel Yuen, Salvador R Franco, Johannes C von Alvensleben, Gareth J Morgan, Jenny E Zablah

Author Information

Natalie Soszyn: School of Medicine, Children's Hospital Colorado, The Heart Institute, University of Colorado Denver|Anschutz Medical Campus, 13123 E 16Th Ave, Box 100, Aurora, CO, 80045-2560, USA.
Gabriel Yuen: The Heart Institute, Children's Hospital Colorado, 13123 E 16Th Ave, Box 100, Aurora, CO, 80045-2560, USA.
Salvador R Franco: The Heart Institute, Children's Hospital Colorado, 13123 E 16Th Ave, Box 100, Aurora, CO, 80045-2560, USA.
Johannes C von Alvensleben: School of Medicine, Children's Hospital Colorado, The Heart Institute, University of Colorado Denver|Anschutz Medical Campus, 13123 E 16Th Ave, Box 100, Aurora, CO, 80045-2560, USA.
Gareth J Morgan: School of Medicine, Children's Hospital Colorado, The Heart Institute, University of Colorado Denver|Anschutz Medical Campus, 13123 E 16Th Ave, Box 100, Aurora, CO, 80045-2560, USA.
Jenny E Zablah: School of Medicine, Children's Hospital Colorado, The Heart Institute, University of Colorado Denver|Anschutz Medical Campus, 13123 E 16Th Ave, Box 100, Aurora, CO, 80045-2560, USA. jenny.zablah@childrenscolorado.org.

PMID: 39828809 DOI: 10.1007/s00246-024-03767-4

Though major complications during transcutaneous pulmonary valve replacement (TPVR) are rare, clinically-significant ventricular arrythmia (CSVA) has been reported following self-expanding valve placement. We assess whether alterations in valve frame dimensions and geometry within the right ventricular outflow tract (RVOT) post-implantation in patients who underwent TPVR with Harmony TPV25 or Alterra contribute to CSVA risk. A single center review was performed of patients who underwent TPVR with either Harmony TPV25 or Alterra Pre-stent between August 2019 and April 2023. Using post-procedural 3D rotational acquisitions, minimum and maximum diameters were measured at 5 locations along the valve frame and perimeter and cross-sectional area (CSA) were measured closest to the pulmonary artery bifurcation and right ventricular (RV) cavity. To assess the relationship between the RVOT and valve frame, a RVOT-to-valve frame ratio together with percentage expansion, circularity and expansion ratios, and eccentricity indices were calculated. Twenty-eight patients were included (14 Harmony TPV25, 14 Alterra pre-stent). CSVA was seen more often in patients with congenital pulmonary stenosis (p��=��0.02). CSVA was associated with a larger mean valve frame perimeter (118.3 vs 108.6 mm, p��=��0.03) and CSA (1124.5 vs 926.2mm, p��=��0.03) closest to the RV cavity. No associations between difference in diameters, RVOT-to-valve frame ratio, parameters evaluating valve frame geometry, and level of implant and CSVA were demonstrated. No single mechanism was identified that contributed to CSVA in patients following self-expanding valve implantation. Future studies implementing these mathematical constructs and measurements to a larger cohort of self-expanding valve patients may yield more instructive results.

Alterra Arrythmia Harmony Self-expanding Transcatheter pulmonary valve replacement Valve geometry

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