The Journal of thoracic and cardiovascular surgery, 2018
Stented bioprosthetic valves (BPVs) are commonly used for surgical pulmonary valve (PV) replaceme... more Stented bioprosthetic valves (BPVs) are commonly used for surgical pulmonary valve (PV) replacement in postoperative congenital heart disease, but develop structural failure in a time-related fashion. The Melody transcatheter PV (TPV) (Medtronic, Minneapolis, Minn) has been used to treat BPV dysfunction, but there have been few studies in this population. We performed a retrospective, multicenter study to evaluate Melody valve function in patients who underwent TPV replacement (TPVR) into a dysfunctional pulmonary BPV. One hundred patients who underwent TPVR at 10 centers between January 2010 and June 2015 were enrolled. The median patient age was 22 years (range, 5-79 years), and 32 patients were age <18 years. The underlying diagnosis was tetralogy of Fallot in 80 patients, and moderate or severe pulmonary regurgitation (PR) was present in 84%. The TPV was implanted into various types of BPVs, with a median size of 23 mm (range, 19-33 mm). At hospital discharge, PR was mild or ...
There are limited follow-up studies examining surgical and catheter-based reinterventions in long... more There are limited follow-up studies examining surgical and catheter-based reinterventions in long-term survivors of the Fontan operation. All 773 patients who underwent Fontan at our institution between 1992 and 2009 were retrospectively reviewed. Current information regarding post-Fontan intervention was available for 70%. By 20 years after Fontan, 65% of patients had experienced either surgical or transcatheter intervention. The median time to first reintervention was 9.8 years. Freedom from reoperation was 69% at 15 years and 63% at 20 years. The most common operations were pacemaker placement and Fontan revision. Risk factors for pacemaker placement included systemic left ventricle (hazard ratio [HR], 2.2; P=0.006) and lateral tunnel Fontan (HR, 4.3; P=0.001). Freedom from interventional catheterization was 53% at 15 years and 50% at 20 years. The most common procedures performed were fenestration closure and pulmonary artery intervention. Catheter intervention for anatomic indi...
Transcatheter pulmonary valve replacement (TPVR) is an established therapy for dysfunctional righ... more Transcatheter pulmonary valve replacement (TPVR) is an established therapy for dysfunctional right ventricular (RV) outflow tract conduits. TPVR in patients with congenitally corrected transposition of the great arteries, subpulmonary left ventricle, and left ventricular outflow tract (LVOT) conduit dysfunction has not been studied. Unique anatomic and physiological aspects of this population may contribute to distinct risks and outcomes. Across 10 US centers, 27 patients with a dysfunctional LVOT conduit were evaluated in the catheterization laboratory between December 2008 and August 2015 with the intent to perform TPVR. TPVR was successful in 23 patients (85%). Five serious adverse events occurred in 4 cases (15%), including pulmonary hemorrhage, hypotension requiring vasoactive support, conduit disruption requiring covered stent (n=2), and acute RV dysfunction with flash pulmonary edema. After TPVR, the LVOT peak systolic ejection gradient decreased from median of 35 to 17 mm Hg...
Background: The practice of coiling aortopulmonary collateral arteries (APC) before the Fontan pr... more Background: The practice of coiling aortopulmonary collateral arteries (APC) before the Fontan procedure is controversial. We sought to compare outcomes in patients (pts) with and without pre-Fontan coil embolization of APCs using the PHN Cross-Sectional Fontan Study database. Methods: We compared hospital length of stay (LOS) after Fontan in pts who did (“coil group,” n=80) vs did not (“no coil group”, n=459) undergo APC coiling. Information on APC size and number was not available. Secondary outcomes included complications after Fontan and testing at cross-sectional follow-up. Patients requiring Fontan conversion (7) were excluded. Univariate methods and multivariate regression, adjusting for potential confounders, were used to compare outcomes. Results: The 7 PHN centers varied markedly in frequency of pre-Fontan APC coiling (range 0 –30%, p Conclusion: Management of APCs before Fontan shows marked practice variation. In this retrospective analysis, pre-Fontan coiling of APCs was associated neither with faster postoperative recovery nor with better late outcomes. Because we cannot exclude residual confounding, a randomized clinical trial of this practice is needed.
Introduction Anomalous origin of the right or left coronary artery (AORCA or AOLCA) from the cont... more Introduction Anomalous origin of the right or left coronary artery (AORCA or AOLCA) from the contralateral sinus of Valsalva is a congenital heart defect associated with exercise-induced ischemia a...
Journal of the American College of Cardiology, Jan 15, 2015
Cardiac catheterization is the standard of care procedure for diagnosis, choice of therapy, and l... more Cardiac catheterization is the standard of care procedure for diagnosis, choice of therapy, and longitudinal follow-up of children and adults with pulmonary hypertension (PH). However, the procedure is invasive and has risks associated with both the procedure and recovery period. The purpose of this study was to identify risk factors for catastrophic adverse outcomes in children with PH undergoing cardiac catheterization. We studied children and young adults up to 21 years of age with PH undergoing 1 or more cardiac catheterization at centers participating in the Pediatric Health Information Systems database between 2007 and 2012. Using mixed-effects multivariable regression, we assessed the association between pre-specified subject- and procedure-level covariates and the risk of the composite outcome of death or initiation of mechanical circulatory support within 1 day of cardiac catheterization after adjustment for patient- and procedure-level factors. A total of 6,339 procedures ...
Background— Transcatheter pulmonary valve implantation using the Melody valve has emerged as an i... more Background— Transcatheter pulmonary valve implantation using the Melody valve has emerged as an important therapy for the treatment of postoperative right ventricular outflow tract dysfunction. Melody-in-bioprosthetic valves (BPV) is currently considered an off-label indication. We review the combined experience with transcatheter pulmonary valve implantation within BPVs from 8 centers in the United States and discuss technical aspects of the Melody-in-BPV procedure. Methods and Results— A total of 104 patients underwent Melody-in-BPV in the pulmonary position at 8 US centers from April 2007 to January 2012. Ten different types of BPVs were intervened on, with Melody valve implantation at the intended site in all patients. Following Melody valve implant, the peak right ventricle-to-pulmonary artery gradient decreased from 38.7±16.3 to 10.9±6.7 mm Hg ( P <0.001), and the right ventricular systolic pressure fell from 71.6±21.7 to 46.7±15.9 mm Hg ( P <0.001). There was no serious...
The Journal of thoracic and cardiovascular surgery, 2018
Stented bioprosthetic valves (BPVs) are commonly used for surgical pulmonary valve (PV) replaceme... more Stented bioprosthetic valves (BPVs) are commonly used for surgical pulmonary valve (PV) replacement in postoperative congenital heart disease, but develop structural failure in a time-related fashion. The Melody transcatheter PV (TPV) (Medtronic, Minneapolis, Minn) has been used to treat BPV dysfunction, but there have been few studies in this population. We performed a retrospective, multicenter study to evaluate Melody valve function in patients who underwent TPV replacement (TPVR) into a dysfunctional pulmonary BPV. One hundred patients who underwent TPVR at 10 centers between January 2010 and June 2015 were enrolled. The median patient age was 22 years (range, 5-79 years), and 32 patients were age <18 years. The underlying diagnosis was tetralogy of Fallot in 80 patients, and moderate or severe pulmonary regurgitation (PR) was present in 84%. The TPV was implanted into various types of BPVs, with a median size of 23 mm (range, 19-33 mm). At hospital discharge, PR was mild or ...
There are limited follow-up studies examining surgical and catheter-based reinterventions in long... more There are limited follow-up studies examining surgical and catheter-based reinterventions in long-term survivors of the Fontan operation. All 773 patients who underwent Fontan at our institution between 1992 and 2009 were retrospectively reviewed. Current information regarding post-Fontan intervention was available for 70%. By 20 years after Fontan, 65% of patients had experienced either surgical or transcatheter intervention. The median time to first reintervention was 9.8 years. Freedom from reoperation was 69% at 15 years and 63% at 20 years. The most common operations were pacemaker placement and Fontan revision. Risk factors for pacemaker placement included systemic left ventricle (hazard ratio [HR], 2.2; P=0.006) and lateral tunnel Fontan (HR, 4.3; P=0.001). Freedom from interventional catheterization was 53% at 15 years and 50% at 20 years. The most common procedures performed were fenestration closure and pulmonary artery intervention. Catheter intervention for anatomic indi...
Transcatheter pulmonary valve replacement (TPVR) is an established therapy for dysfunctional righ... more Transcatheter pulmonary valve replacement (TPVR) is an established therapy for dysfunctional right ventricular (RV) outflow tract conduits. TPVR in patients with congenitally corrected transposition of the great arteries, subpulmonary left ventricle, and left ventricular outflow tract (LVOT) conduit dysfunction has not been studied. Unique anatomic and physiological aspects of this population may contribute to distinct risks and outcomes. Across 10 US centers, 27 patients with a dysfunctional LVOT conduit were evaluated in the catheterization laboratory between December 2008 and August 2015 with the intent to perform TPVR. TPVR was successful in 23 patients (85%). Five serious adverse events occurred in 4 cases (15%), including pulmonary hemorrhage, hypotension requiring vasoactive support, conduit disruption requiring covered stent (n=2), and acute RV dysfunction with flash pulmonary edema. After TPVR, the LVOT peak systolic ejection gradient decreased from median of 35 to 17 mm Hg...
Background: The practice of coiling aortopulmonary collateral arteries (APC) before the Fontan pr... more Background: The practice of coiling aortopulmonary collateral arteries (APC) before the Fontan procedure is controversial. We sought to compare outcomes in patients (pts) with and without pre-Fontan coil embolization of APCs using the PHN Cross-Sectional Fontan Study database. Methods: We compared hospital length of stay (LOS) after Fontan in pts who did (“coil group,” n=80) vs did not (“no coil group”, n=459) undergo APC coiling. Information on APC size and number was not available. Secondary outcomes included complications after Fontan and testing at cross-sectional follow-up. Patients requiring Fontan conversion (7) were excluded. Univariate methods and multivariate regression, adjusting for potential confounders, were used to compare outcomes. Results: The 7 PHN centers varied markedly in frequency of pre-Fontan APC coiling (range 0 –30%, p Conclusion: Management of APCs before Fontan shows marked practice variation. In this retrospective analysis, pre-Fontan coiling of APCs was associated neither with faster postoperative recovery nor with better late outcomes. Because we cannot exclude residual confounding, a randomized clinical trial of this practice is needed.
Introduction Anomalous origin of the right or left coronary artery (AORCA or AOLCA) from the cont... more Introduction Anomalous origin of the right or left coronary artery (AORCA or AOLCA) from the contralateral sinus of Valsalva is a congenital heart defect associated with exercise-induced ischemia a...
Journal of the American College of Cardiology, Jan 15, 2015
Cardiac catheterization is the standard of care procedure for diagnosis, choice of therapy, and l... more Cardiac catheterization is the standard of care procedure for diagnosis, choice of therapy, and longitudinal follow-up of children and adults with pulmonary hypertension (PH). However, the procedure is invasive and has risks associated with both the procedure and recovery period. The purpose of this study was to identify risk factors for catastrophic adverse outcomes in children with PH undergoing cardiac catheterization. We studied children and young adults up to 21 years of age with PH undergoing 1 or more cardiac catheterization at centers participating in the Pediatric Health Information Systems database between 2007 and 2012. Using mixed-effects multivariable regression, we assessed the association between pre-specified subject- and procedure-level covariates and the risk of the composite outcome of death or initiation of mechanical circulatory support within 1 day of cardiac catheterization after adjustment for patient- and procedure-level factors. A total of 6,339 procedures ...
Background— Transcatheter pulmonary valve implantation using the Melody valve has emerged as an i... more Background— Transcatheter pulmonary valve implantation using the Melody valve has emerged as an important therapy for the treatment of postoperative right ventricular outflow tract dysfunction. Melody-in-bioprosthetic valves (BPV) is currently considered an off-label indication. We review the combined experience with transcatheter pulmonary valve implantation within BPVs from 8 centers in the United States and discuss technical aspects of the Melody-in-BPV procedure. Methods and Results— A total of 104 patients underwent Melody-in-BPV in the pulmonary position at 8 US centers from April 2007 to January 2012. Ten different types of BPVs were intervened on, with Melody valve implantation at the intended site in all patients. Following Melody valve implant, the peak right ventricle-to-pulmonary artery gradient decreased from 38.7±16.3 to 10.9±6.7 mm Hg ( P <0.001), and the right ventricular systolic pressure fell from 71.6±21.7 to 46.7±15.9 mm Hg ( P <0.001). There was no serious...
Uploads
Papers by Matthew Gillespie