Transcatheter pulmonary valve implantation: will it replace surgical pulmonary valve replacement?

Introduction: Right ventricular outflow tract (RVOT) dysfunction is a common hemodynamic challenge for adults with congenital heart disease (ACHD), including patients with repaired tetralogy of Fallot (TOF), truncus arteriosus (TA), and those who have undergone the Ross procedure for congenital aortic stenosis and the Rastelli repair for transposition of great vessels. Pulmonary valve replacement (PVR) has become one of the most common procedures performed for ACHD patients.

Areas covered: Given the advances in transcatheter technology, we conducted a detailed review of the available studies addressing the indications for PVR, historical background, evolving technology, procedural aspects, and the future direction, with an emphasis on ACHD patients.

Expert commentary: Transcatheter pulmonary valve implantation (TPVI) is widely accepted as an alternative to surgery to address RVOT dysfunction. However, current technology may not be able to adequately address a subset of patients with complex RVOT morphology. As the technology continues to evolve, new percutaneous valves will allow practitioners to apply the transcatheter approach in such patients. We expect that with the advancement in transcatheter technology, novel devices will be added to the TPVI armamentarium, making the transcatheter approach a feasible alternative for the majority of patients with RVOT dysfunction in the near future.     

Echocardiographic Assessment of Melody Versus Sapien Valves Following Transcatheter Pulmonary Valve Replacement

ObjectivesThe aim of this study was to compare the immediate and midterm echocardiographic performance of the Melody (Medtronic Inc) and Sapien (Edwards Lifesciences Inc) valves after transcatheter pulmonary valve replacement (TPVR) in native and conduit right ventricular outflow tracts (RVOTs).BackgroundTPVR is now a common procedure, but limited data exist comparing postimplantation echocardiographic findings between Melody and Sapien valves.MethodsThis was a single-institution retrospective cohort study of all patients who underwent successful TPVR from 2011 to 2020. Patient demographics, procedural details, and immediate and midterm echocardiographic findings were collected and compared between valve types using the Wilcoxon rank sum, chi-square, or Fisher exact test as appropriate. Subgroups were analyzed individually and were adjusted for multiple comparisons using the Bonferroni method.ResultsA total of 328 patients underwent successful TPVR (Melody: n = 202, Sapien: n = 126). The groups had a similar baseline age, weight, and diagnosis. The most common indications for TPVR were pulmonary stenosis (32.2%) or mixed disease (46%) in the Melody group and pulmonary insufficiency in the Sapien group (52.4%) (P < 0.001). Sapien valves were more often placed in native RVOTs (43.7% vs 18.8%; P < 0.001). The discharge and follow-up mean and peak Doppler gradients were similar between the Melody and Sapien groups. Valves implanted in native RVOTs had significantly lower postimplantation gradients at each follow-up period.ConclusionsEchocardiographic performance after TPVR was generally acceptable and similar when comparing Melody and Sapien valves despite differences in the indication and anatomy in each group. The peak and mean gradients were lower in transcatheter valves implanted in native RVOTs compared with those implanted in conduits or bioprosthetic valves.     

Application of transcatheter valves for aortic valve replacement in pediatric patients: A case series

• Diabetic patients are frequently affected by coronary artery disease (CAD) and are at increased risk of CAD‐related adverse events, even after drug‐eluting stent (DES) implantation. If currently available DES have similar safety and efficacy in diabetic and nondiabetic patients is still debated.
• This prospective, multicenter registry showed similar 3‐year outcome in patients undergoing different DES implantation, although diabetic patients, especially those requiring insulin treatment, had significantly higher risk of adverse events than nondiabetic patients.
• Specific efforts to improve the performance of DES in diabetic patients are mandatory to adequately address the unsolved issue of diabetic patients affected by CAD.

     

旋律音调疗法联合拮抗肌推拿对脑出血术后偏瘫患者躯体屈曲痉挛和运动功能的影响

目的探讨旋律音调疗法联合拮抗肌推拿对脑出血术后偏瘫患者的躯体屈曲痉挛和运动功能的影响。方法采用整群抽样法,选取本院2017年6月至2018年12月收治的87例脑出血术后偏瘫患者为研究对象,将其随机分为研究组44例和对照组43例,对照组实施常规护理,研究组实施旋律音调疗法联合拮抗肌推拿护理。干预后6个月,比较两组接受躯体屈曲痉挛和运动功能。结果干预前,研究组躯体屈曲痉挛分级、肢体运动功能评分比较差异无统计学意义(P>0.05);干预后,研究组躯体屈曲痉挛分级低于对照组、肢体运动功能评分高于对照组(P<0.05)。结论脑出血术后偏瘫应用旋律音调疗法联合拮抗肌推拿护理,可有效改善躯体屈曲痉挛,恢复运动功能,具有推广价值。     

Learning and Liking of Melody and Harmony: Further Studies in Artificial Grammar Learning

Much of what we know and love about music is based on implicitly acquired mental representations of musical pitches and the relationships between them. While previous studies have shown that these mental representations of music can be acquired rapidly and can influence preference, it is still unclear which aspects of music influence learning and preference formation. This article reports two experiments that use an artificial musical system to examine two questions: (1) which aspects of music matter most for learning, and (2) which aspects of music matter most for preference formation. Two aspects of music are tested: melody and harmony. In Experiment 1 we tested the learning and liking of a new musical system that is manipulated melodically so that only some of the possible conditional probabilities between successive notes are presented. In Experiment 2 we administered the same tests for learning and liking, but we used a musical system that is manipulated harmonically to eliminate the property of harmonic whole‐integer ratios between pitches. Results show that disrupting melody (Experiment 1) disabled the learning of music without disrupting preference formation, whereas disrupting harmony (Experiment 2) does not affect learning and memory but disrupts preference formation. Results point to a possible dissociation between learning and preference in musical knowledge.     

Safety and Feasibility of Melody Transcatheter Pulmonary Valve Replacement in the Native Right Ventricular Outflow Tract: A Multicenter Pediatric Heart Network Scholar Study

Objectives

This study sought to determine the safety and feasibility of transcatheter pulmonary valve replacement (TPVR) using the Melody valve in native (nonconduit) right ventricular outflow tracts (nRVOT), and to identify factors associated with successful TPVR.