Martin MH, et al. - With respect to the safety and feasibility of transcatheter pulmonary valve replacement (TPVR) in children weighing less than 20 kg, researchers concluded, based on the findings of this review, that percutaneous TPVR can be safely performed in this patient population. Data also indicated that this technique frequently requires internal jugular vein (IJV) access and may be more commonly associated with access site/bleeding complications in this cohort.

Methods

• This review was performed on all patients weighing <20 kg who underwent catheterization for percutaneous TPVR at 4 centers.

Results

• A total of 51 patients were reviewed, successful valve implantation was reported in 43 (84%) and 8 (16%) were found not to be candidates due to access veins too small (n = 3), coronary artery/aortic root compression (n = 3), and RVOT too large (n = 2).
• Researchers noted that the 43 patients who underwent successful percutaneous TPVR had a median age and weight of 5.8 years (3.3–10) and 17.7 kg (13.5–19.8), and most had tetralogy of Fallot (TOF).
• Using femoral vein (FV) access and internal jugular vein (IJV) access, TPVR was performed in 24 patients and in 19 patients, respectively.
• In patients with IJV implant, 1.1 kg lower median weight was documented, as compared with those who underwent transfemoral implant (17.0 vs 18.1 kg, P=0.05).
• The following 4 adverse events were observed: 1 iliac vein injury, 1 contained MPA tear, and 2 patients with post-procedure femoral vein bleeding.
• A recent follow-up performed at a median of 2.0 years (0.1–6.0) after TPVR revealed that all patients were alive.
• Furthermore, findings demonstrated excellent valve function with mean Doppler gradients of 3–20 mm Hg, and trivial or mild pulmonary regurgitation in all but 1 patient.
• Data reported no RVOT reinterventions and no cases of endocarditis.