Article ; Online: Use of the Inspiris valve in the native right ventricular outflow tract is associated with early prosthetic regurgitation.
The Journal of thoracic and cardiovascular surgery
2023 Volume 166, Issue 4, Page(s) 1210–1221.e8
Abstract: Objective: The Inspiris Resilia prosthesis (Edwards Lifesciences) has been increasingly used in the pulmonic position with limited performance data. We sought to investigate its durability as a surgical pulmonary valve replacement (PVR).: Methods: We ...
| Abstract | Objective: The Inspiris Resilia prosthesis (Edwards Lifesciences) has been increasingly used in the pulmonic position with limited performance data. We sought to investigate its durability as a surgical pulmonary valve replacement (PVR). Methods: We retrospectively reviewed patients who underwent PVR or conduit replacement with an Inspiris or non-Inspiris valve/conduit from 2018 to 2022. The primary end point was freedom from a composite of at least moderate pulmonary regurgitation, pulmonary stenosis, or valve/conduit reintervention. Secondary end points were individual components of the composite outcome. To account for baseline differences, propensity matching identified 70 patient pairs. Results: A total of 227 patients (median age: 19.3 years [interquartile range, 11.8-34.4]) underwent PVR or conduit replacement (Inspiris: n = 120 [52.9%], non-Inspiris: n = 107 [47.1%]). Median follow-up was 26.6 months [interquartile range, 12.4-41.1]. Among matched patients, 2-year freedom from valve failure was lower in the Inspiris group (53.5 ± 9.3% vs 78.5 ± 5.9%, P = .03), as was freedom from at least moderate pulmonary regurgitation (54.2 ± 9.6% vs 86.4 ± 4.9%, P < .01). There was no difference in 2-year freedom from at least moderate pulmonary stenosis (P = .61) or reintervention (P = .92). Inspiris durability was poorer when implanted in the native right ventricular outflow tract compared with as a conduit, with 18-month freedom from valve failure of 59.0 ± 9.5% versus 85.9 ± 9.5% (P = .03). Conclusions: Early durability of the Inspiris valve is poor when implanted in the native right ventricular outflow tract; its unique design may be incompatible with the compliant pulmonary root. Modified implantation techniques or alternative prostheses should be considered. |
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| MeSH term(s) | Humans ; Young Adult ; Adult ; Pulmonary Valve/diagnostic imaging ; Pulmonary Valve/surgery ; Heart Valve Prosthesis Implantation/adverse effects ; Heart Valve Prosthesis Implantation/methods ; Treatment Outcome ; Retrospective Studies ; Pulmonary Valve Insufficiency/diagnostic imaging ; Pulmonary Valve Insufficiency/etiology ; Pulmonary Valve Insufficiency/surgery ; Pulmonary Valve Stenosis/diagnostic imaging ; Pulmonary Valve Stenosis/surgery ; Heart Valve Prosthesis ; Prosthesis Design ; Ventricular Outflow Obstruction/diagnostic imaging ; Ventricular Outflow Obstruction/etiology ; Ventricular Outflow Obstruction/surgery |
| Language | English |
| Publishing date | 2023-04-22 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 3104-5 |
| ISSN | 1097-685X ; 0022-5223 |
| ISSN (online) | 1097-685X |
| ISSN | 0022-5223 |
| DOI | 10.1016/j.jtcvs.2023.04.018 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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