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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 ,
Darren P. Berman ,
Martin L. Bocks ,
Sunkyung Yu ,
Evan M. Zahn ,
Jimmy C. Lu ,
Justin A. Shaya  and
Aimee K. Armstrong
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]
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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.

Keywords

Transcatheter pulmonary valvecongenital heart diseaseinterventional paediatric cardiology
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 948 - 956
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Copyright
© Cambridge University Press 2015 

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