Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-05T03:19:24.517Z Has data issue: false hasContentIssue false

Factors associated with the internal jugular venous approach for Melody™ Transcatheter Pulmonary Valve implantation

Published online by Cambridge University Press:  02 November 2015

Jeffrey D. Zampi*
Affiliation:
Department of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
Darren P. Berman
Affiliation:
Department of Pediatric Cardiology, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
Martin L. Bocks
Affiliation:
Department of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
Sunkyung Yu
Affiliation:
Department of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
Evan M. Zahn
Affiliation:
Department of Pediatric Cardiology, Cedars-Sinai Hospital, Los Angeles, California, United States of America
Jimmy C. Lu
Affiliation:
Department of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
Justin A. Shaya
Affiliation:
University of Michigan Medical School, Ann Arbor, Michigan, United States of America
Aimee K. Armstrong
Affiliation:
Department of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
*
Correspondence to: J. D. Zampi, MD, Department of Pediatric Cardiology, University of Michigan Congenital Heart Center, 1540 East Hospital Drive, Ann Arbor, MI 48109, United States of America. Tel: 734 936 8997; Fax: 734 936 9470; E-mail: [email protected]

Abstract

Background

Transcatheter pulmonary valve implantation is usually performed from a femoral venous – transfemoral – approach, but this may not be the optimal vascular access option in some patients. This study aimed to determine which group of patients might benefit from an internal jugular – transjugular – approach for transcatheter pulmonary valve implantation.

Methods

This multicentre retrospective study included all patients who underwent attempted transcatheter pulmonary valve placement in the right ventricular outflow tract between April 2010 and June 2012 at two large congenital heart centres. Patients were divided into two groups based on venous access site – transfemoral or transjugular. Patient characteristics, procedural outcomes, and complications were compared between groups.

Results

Of 81 patients meeting the inclusion criteria (median age 16.4 years), the transjugular approach was used in 14 patients (17%). The transjugular group was younger (median age 11.9 versus 17.3 years), had lower body surface area (mean 1.33 versus 1.61 m2), more often had moderate or greater tricuspid regurgitation (29% versus 7%), and had a higher ratio of right ventricle-to-systemic systolic pressure (mean 82.4 versus 64.7). Patients requiring a transjugular approach after an unsuccessful transfemoral approach had longer fluoroscopic times and procedure duration.

Conclusions

The transjugular approach for transcatheter pulmonary valve implantation is used infrequently but is more often used in younger and smaller patients. Technical limitations from a transfemoral approach may be anticipated if there is moderate or greater tricuspid regurgitation or higher right ventricular pressures. In these patients, a transjugular approach should be considered early.

Type
Original Articles
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. McElhinney, DB, Hellenbrand, WE, Zahn, EM, et al. Short- and medium-term outcomes after transcatheter pulmonary valve placement in the expanded multicenter US Melody valve trial. Circulation 2010; 122: 507516.Google Scholar
2. Butera, G, Milanesi, O, Spadoni, I, et al. Melody transcatheter pulmonary valve implantation. Results from the registry of the Italian Society of Pediatric Cardiology (SICP). Catheter Cardiovasc Interv 2013; 81: 310316.Google Scholar
3. Fraisse, A, Aldebert, P, Malekzadeh-Milani, S, et al. Melody (R) transcatheter pulmonary valve implantation: results from a French registry. Arch Cardiovasc Dis 2014; 107: 607614.Google Scholar
4. Berman, DP, McElhinney, DB, Vincent, JA, Hellenbrand, WE, Zahn, EM. Feasibility and short-term outcomes of percutaneous transcatheter pulmonary valve replacement in small (<30 kg) children with dysfunctional right ventricular outflow tract conduits. Circ Cardiovasc Interv 2014; 7: 142148.Google Scholar
5. Armstrong, AK, Balzer, DT, Cabalka, AK, et al. One-year follow-up of the Melody transcatheter pulmonary valve multicenter post-approval study. JACC Cardiovasc Interv 2014; 7: 12541262.Google Scholar
6. Batlivala, SP, Emani, S, Mayer, JE, McElhinney, DB. Pulmonary valve replacement function in adolescents: a comparison of bioprosthetic valves and homograft conduits. Ann Thorac Surg 2012; 93: 20072016.CrossRefGoogle ScholarPubMed
7. Bielefeld, MR, Bishop, DA, Campbell, DN, Mitchell, MB, Grover, FL, Clarke, DR. Reoperative homograft right ventricular outflow tract reconstruction. Ann Thorac Surg 2001; 71: 482487; discussion 487–488.CrossRefGoogle ScholarPubMed
8. Stark, J, Bull, C, Stajevic, M, Jothi, M, Elliott, M, de Leval, M. Fate of subpulmonary homograft conduits: determinants of late homograft failure. J Thorac Cardiovasc Surg 1998; 115: 506514; ; discussion 514–506.CrossRefGoogle ScholarPubMed
9. Wells, WJ, Arroyo, H Jr, Bremner, RM, Wood, J, Starnes, VA. Homograft conduit failure in infants is not due to somatic outgrowth. J Thorac Cardiovasc Surg 2002; 124: 8896.CrossRefGoogle Scholar
10. Bonhoeffer, P, Boudjemline, Y, Saliba, Z, et al. Transcatheter implantation of a bovine valve in pulmonary position: a lamb study. Circulation 2000; 102: 813816.Google Scholar
11. Bonhoeffer, P, Boudjemline, Y, Saliba, Z, et al. Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction. Lancet 2000; 356: 14031405.Google Scholar
12. Khambadkone, S, Bonhoeffer, P. Percutaneous implantation of pulmonary valves. Expert Rev Cardiovasc Ther 2003; 1: 541548.Google Scholar
13. Khambadkone, S, Bonhoeffer, P. Nonsurgical pulmonary valve replacement: why, when, and how? Catheter Cardiovasc Interv 2004; 62: 401408.Google Scholar
14. Lurz, P, Coats, L, Khambadkone, S, et al. Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome. Circulation 2008; 117: 19641972.Google Scholar
15. Zahn, EM, Hellenbrand, WE, Lock, JE, McElhinney, DB. Implantation of the Melody transcatheter pulmonary valve in patients with a dysfunctional right ventricular outflow tract conduit early results from the U.S. clinical trial. J Am Coll Cardiol 2009; 54: 17221729.Google Scholar
16. Chen, W, Yao, Y, Zhang, S, He, DS. Comparison of operator radiation exposure during coronary sinus catheter placement via the femoral or jugular vein approach. Europace 2011; 13: 539542.Google Scholar
17. Fetterly, KA, Magnuson, DJ, Tannahill, GM, Hindal, MD, Mathew, V. Effective use of radiation shields to minimize operator dose during invasive cardiology procedures. JACC Cardiovasc Interv 2011; 4: 11331139.Google Scholar
18. Liu, XY, Wong, V, Leung, M. Neurologic complications due to catheterization. Pediatr Neurol 2001; 24: 270275.Google Scholar