In June, AdventHealth for Children pediatric interventional cardiologists were the first in Florida to implant a tetralogy of Fallout patient with the Alterra Adaptive Prestent and Valve Implant to correct severe pulmonary regurgitation without open-heart surgery.
Patients with congenital heart diseases where the pulmonary artery is involved, including tetralogy of Fallout, transposition of the great arteries (TGA), and truncus arteriosus, often suffer from right ventricular outflow tract (RVOT) dysfunction after their initial surgical repair. This can lead to decreased exercise capacity and increased risk of malignant arrhythmias. Over the course of a lifetime, these patients typically require several pulmonary valve replacements to correct RVOT dysfunction.
“Before availability of the new Alterra prestent and valve technology, placing valves using percutaneous technology was only possible if the pulmonary valve was a maximum of 28 mm,” explains Zahid Amin, MD, Medical Director of Pediatric and Congenital Cardiology at AdventHealth for Children. “If it was larger, repair required that the patient undergo open-heart surgery, and more than 50% of tetralogy of Fallout patients have valves larger than 28 mm.”
AdventHealth for Children
The new Alterra transcatheter technology was approved in December 2021 by the U.S. Food and Drug Administration (FDA) for patients who weigh over 20 kilograms, and it can accommodate valves up to 40 mm.
“This significantly increases the number of patients who can have their valve replaced through an interventional approach,” shares Dr. Amin. “Most of these patients are able to go home the morning after the procedure and can be back to work within a few days.”
There are more adult survivors of tetralogy of Fallout than any other cyanotic heart disease with 30-year survival rates ranging from 78% to 95% for those without other genetic conditions. Because the average lifespan of pulmonary valve implants is about 10 years, many of these patients have already had multiple open-heart surgeries.
“Each surgery becomes increasingly difficult for the patient in terms of pain and recovery time in addition to the risk of infection and anxiety that comes with the more invasive approach,” says Dr. Amin. “With the new Alterra implant technology, a valve can be placed and then another valve within that valve, allowing these patients to go 20 to 30 years before they require another open-heart surgery and reducing the total number of open-heart surgeries they may need over their lifetime. This is a tremendous benefit for our patients.”
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