Conference Coverage

Harmony pulmonary valve update: Regurgitation resolved 1 year out



The 1-year results of the Harmony transcatheter pulmonary valve to treat severe pulmonary regurgitation have shown a high rate of eliminating or reducing the degree of symptoms as well as freedom from endocarditis, sustained ventricular tachycardia, and the need for further interventions.

“Simply put, the good news is no endocarditis,” said Daniel S. Levi, MD, in presenting results from three different studies with 108 patients who received three different iterations of the device at the Society for Cardiovascular Angiography & Interventions annual scientific sessions.

Daniel S. Levi,an interventional pediatric cardiologist at the David Geffen School of Medicine at UCLA courtesy University of California, Los Angeles

Dr. Daniel S. Levi

“Endocarditis has been an issue for us in the pulmonary position; we have yet to have an endocarditis in these patients in 1 year,” he stressed.

The studies evaluated three different versions of the Harmony valve: TPV22 (42 patients), the first version with a 22-mm diameter; the Clinical TPV25 (17 patients), the first iteration of a 25 mm–wide device that has since been discontinued; and the modified TPV25 (45 patients), the second version of the 25-mm valve. The three studies are the early feasibility study of the TPV22, the continued-access study of the TPV22 and the mTPV25, and the pivotal study that included all three versions.

At baseline, 89% of patients had severe and 11% had moderate pulmonary regurgitation (PR). At 1 year, 92% had none or trace PR, 3% had mild PR, and 4% moderate disease.

Dr. Levi said the device “speaks for itself” in the results he presented. They include no deaths, no heart attacks, and no pulmonary thromboembolism. Other key outcomes include:

  • One major stent fracture in one of the early feasibility study patients at 1-month follow-up.
  • Four explants, with two in the discontinued cTPV25 and two with the TPV22 in the early-feasibility study.
  • Four reinterventions, two with the discontinued cTPV25 and two valve-in-valve procedures with the mTPV25 in the continued-access study, one with stent placement in the right ventricular outflow tract.

Dr. Levi and coinvestigators also performed a breakdown of 1-year outcomes – freedom from PR, stenosis, and interventions – by device: 95.1% for TPV22; 89.7% for mTPV25; and 73.3% for the discontinued cTPV25.

Although the valve is indicated for adolescents and adults, most of the patients in the three studies were adults, with an average weight of 165 pounds (75 kg) who have had PR for decades, said Dr. Levi, an interventional pediatric cardiologist at the University of California, Los Angeles. “With a device like this we are hopefully shifting to treating that a little bit earlier, but fortunately we don’t usually need to treat it before puberty.” The 25-mm TPV gives “a really nice landing zone” for future valve placement. “The goal is to keep patients out of the operating room for at least a few decades if not their whole lives,” he said.

Dr. Levi said the Harmony investigators will follow outcomes with the 22- and modified 25-mm Harmony valves, both of which remain commercially available, out to 10 years.

Dr. Brian Morray of the the University of Washington and an interventional cardiologist at Seattle Children’s Hospital

Dr. Brian Morray

The study represents the first collective cohort evaluating the Harmony device across the early feasibility, continued access and pivotal studies, said Brian Morray, MD. “It’s important that people understand that evolution and how that impacts the way we look at outcomes, because when you aggregate the data, particularly for the TPV25, some of the procedural outcomes and the adverse events are no longer really reflective in the current time frame.”

These Harmony results “represent another big step in the evolution of interventional cardiology and will be up there with development of the Melody valve and the utility and the use of the Sapien valve in the pulmonary position,” said Dr. Morray, an associate professor of pediatrics at the University of Washington, Seattle, and an interventional cardiologist at Seattle Children’s Hospital.

Dr. Levi disclosed he is a consultant to Medtronic and Edwards Lifesciences. Dr. Morray disclosed he is a clinical proctor for Abbott and a consultant to Medtronic, but not for the Harmony device.

Recommended Reading

ISCHEMIA substudy data don’t add up, cardiac surgeons say
MDedge Cardiology
Distal radial snuffbox technique comes up short in DISCO RADIAL
MDedge Cardiology
SCAI issues guidelines for PFO management, makes case for expansion
MDedge Cardiology
SAFE-PAD shows long-term safety of paclitaxel devices
MDedge Cardiology
No-implant interatrial shunt remains patent at a year
MDedge Cardiology
Paradigm-challenging heart failure treatment strategy hopeful in early trial
MDedge Cardiology
Path to parenthood in cardiology training fraught with obstacles
MDedge Cardiology
Hand outcomes similar with distal or proximal radial cardiac cath
MDedge Cardiology
CTO PCI success rates rising, with blip during COVID-19, registry shows
MDedge Cardiology
Data concerns mount despite ISCHEMIA substudy correction
MDedge Cardiology