Percutaneous pulmonary valve implantation: fixing the problems and pushing the envelope.

PURPOSE OF REVIEW: A recent development within pediatric cardiology is percutaneous pulmonary valve implantation (PPVI). This has extended the life of surgical conduits and decreased the number of surgical procedures required. Early reports focused on feasibility and safety of the technique; recent literature has focused on avoidance of complications such as stent fractures and on expanding the procedure to nonconduit implantation. The purpose of this review is to summarize the recent data regarding stent fractures and alternative uses of the valve.

RECENT FINDINGS: Stent fractures following PPVI are reported in 20-28% of patients. Prestenting has recently been shown to be protective and to extend the freedom from stent fractures. The use of PPVI has also been reported in nonconduit positions such as in bioprosthetic tricuspid valves, branch pulmonary arteries, aortic and mitral positions. In addition, the valve has been implanted in higher pressure environments. The short-term success in these applications appears to be quite good.

SUMMARY: PPVI has allowed extension of the life of surgical conduits and failure of the valve is mainly related to stent fractures. Recent developments have minimized this complication. In addition, use of the valve has been extended to nontraditional locations and short-term results are favorable.