Percutaneous Pulmonary Valve Perforation in Pulmonary Atresia With Intact Ventricular Septum: Multicenter Comparison of Radiofrequency Versus Chronic Total Occlusion Wires

TL;DR

This study compares two techniques for a high-risk heart procedure in newborns and finds similar success rates but potential differences in complications.

Contribution

The study provides a multicenter comparison of RF and CTO wires for pulmonary valve perforation in PA/IVS.

Findings

Procedural success rates were similar between RF and CTO wires at 94%.

CTO wire use was associated with smaller balloons and more frequent use of multiple balloons.

RF wire cases had higher complication rates compared to CTO wire cases, though not statistically significant.

Abstract

Percutaneous radiofrequency (RF) wire pulmonary valve perforation (PVP) in pulmonary atresia/intact ventricular septum (PA/IVS) is a high-risk procedure. This study compared procedural efficacy and complications between RF and chronic total occlusion (CTO) wire PVP.

This multicenter study included patients with PA/IVS who had PVP attempted at 13 centers. Outcomes of interest were efficacy and complications. Univariable logistic regression models were used to estimate odds ratios and risk differences.

PVP was attempted in 206 patients; median age 3.0 days (1.0-6.0) and weight 3.1 kg (2.7-3.5). The RF PVP was attempted first in 165 (80.0%) patients, CTO in 27 (13.1%), and stiff end of the coronary wire in 14 (6.8%). The procedural success rate of 94% was similar between wire types. CTO group utilized smaller initial valvuloplasty balloons (2.25 mm [2-3] vs 4 mm [3-6]) and >2 balloons in 71% of cases (vs 18% in RF). Overall and major procedural complications occurred in 26.5% versus 12.5% (odds ratios [OR], 2.5 [0.8-11.1]; P = .15) and 14.8% vs 4.2% (OR, 4.0 [0.8-73.2]; P = .18), respectively, of RF versus CTO groups. Major postprocedural complications occurred in 12% versus 4.2% of the RF versus the CTO groups. Cases with multiple (vs single) PVP attempts had higher overall (40.4% vs 17.0%; OR, 3.3 [1.7-6.6]; P < .01) and major (24.6% vs 8.5%; OR, 3.5 [1.5-8.3], P < .01) procedural complication rates.

PVP remains an effective treatment strategy in PA/IVS. Complication rate differences between CTO and RF wires may be clinically relevant. Further studies with larger cohorts are warranted to confirm findings and guide optimal intervention strategies.

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