{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:08:31Z","timestamp":1792080511764,"version":"4.4.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The Alterra Adaptive Prestent provides a landing zone for implantation of the 29 mm SAPIEN 3 transcatheter heart valve (THV) in patients with a dysfunctional right ventricular outflow tract (RVOT) to treat pulmonary regurgitation (PR). Here, we report 3-year outcomes from a pooled analysis of patients who underwent Alterra\/SAPIEN 3 THV implantation enrolled in the ALTERRA pivotal trial, Continued Access Protocol, and Pulmonic Delivery System Registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This multicenter, prospective trial enrolled patients with moderate or greater PR and RVOT\/pulmonary valve anatomy suitable for implantation. The nonhierarchical composite end point of THV dysfunction was examined at 6 months: RVOT\/pulmonary valve reintervention, moderate or greater PR, and mean RVOT\/pulmonary valve gradient \u226535 mm\u2009Hg. Individual components of the composite, as well as additional clinical and echocardiographic outcomes were examined up to 3 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>The Alterra\/SAPIEN 3 THV system was implanted in 118 patients at 14 sites. At 6 months, THV dysfunction was 3.5% (4\/113). At 3 years, 97.3% of patients in the valve implant population had freedom from reintervention, 100% of patients had a mean RVOT\/pulmonary valve gradients &lt;35 mm\u2009Hg, and 93.3% of patients had mild or lesser total PR. The Kaplan-Meier estimate of all-cause mortality was 3.5% at 3 years. There were no cases of coronary artery compression, hemopericardium, or endocarditis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>This analysis reports the longest follow-up in the largest cohort of patients from the ALTERRA trials. The Alterra Adaptive Prestent with the SAPIEN 3 THV system has shown excellent procedural outcomes and is effective in reducing PR at 3-year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03130777.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.125.015873","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T10:00:14Z","timestamp":1770631214000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Transcatheter Pulmonary Valve Implantation With the Alterra Adaptive Prestent and SAPIEN 3 Transcatheter Heart Valve: 3-Year Pooled Outcomes of the ALTERRA Trials"],"prefix":"10.1161","volume":"19","clinical-trial-number":[{"clinical-trial-number":"nct03130777","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2302-4433","authenticated-orcid":true,"given":"Alejandro J.","family":"Torres","sequence":"first","affiliation":[{"name":"Division of Cardiology, Columbia University Medical Center, New York, NY (A.J.T., R.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8282-5134","authenticated-orcid":true,"given":"V. Vivian","family":"Dimas","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Medical City Children\u2019s Hospital, Dallas, TX (V.V.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1620-9709","authenticated-orcid":true,"given":"Shabana","family":"Shahanavaz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children\u2019s Hospital, OH (S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Balzer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Washington University, St. Louis, MO (D. Balzer)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1500-9334","authenticated-orcid":true,"given":"Gareth","family":"Morgan","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Colorado, University of Colorado, Denver (G.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6951-6660","authenticated-orcid":true,"given":"D. Scott","family":"Lim","sequence":"additional","affiliation":[{"name":"University of Virginia Medical Center, Charlottesville (D.S.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4534-5075","authenticated-orcid":true,"given":"Aimee K.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nationwide Children\u2019s Hospital, Columbus, OH (A.K.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren","family":"Berman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Cardiology, Children\u2019s Hospital Los Angeles, CA (D. Berman)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9438-0846","authenticated-orcid":true,"given":"Vasilis","family":"Babaliaros","sequence":"additional","affiliation":[{"name":"Structural Heart and Valve Center, Emory University, Atlanta, GA (V.B., D.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Kim","sequence":"additional","affiliation":[{"name":"Structural Heart and Valve Center, Emory University, Atlanta, GA (V.B., D.K.)."},{"name":"Children\u2019s Healthcare of Atlanta, GA (D.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Gillespie","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Children\u2019s Hospital of Philadelphia, PA (M.J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9280-6236","authenticated-orcid":true,"given":"Robert","family":"Sommer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Columbia University Medical Center, New York, NY (A.J.T., R.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0209-9505","authenticated-orcid":true,"given":"Jamil","family":"Aboulhosn","sequence":"additional","affiliation":[{"name":"University of California-Los Angeles Adult Congenital Heart Center, Division of Cardiology (J.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4038-1210","authenticated-orcid":true,"given":"Thomas K.","family":"Jones","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Seattle Children\u2019s Hospital, University of Washington (T.K.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6354-1873","authenticated-orcid":true,"given":"Vaikom S.","family":"Mahadevan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester (V.S.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Stapleton","sequence":"additional","affiliation":[{"name":"Medical City Children\u2019s Hospital, Dallas, TX (G. Stapleton)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5744-5370","authenticated-orcid":true,"given":"Ying","family":"Ma","sequence":"additional","affiliation":[{"name":"Edwards Lifesciences, Irvine, CA (Y.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish","family":"Shirali","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Mercy Hospital, Kansas City, MO (G. Shirali)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anitha","family":"Parthiban","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Texas Children\u2019s Hospital, Baylor College of Medicine, Houston (A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Blanke","sequence":"additional","affiliation":[{"name":"St. Paul\u2019s Hospital, Vancouver, British Columbia, Canada (P.B., J.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3892-9029","authenticated-orcid":true,"given":"Jonathon","family":"Leipsic","sequence":"additional","affiliation":[{"name":"St. Paul\u2019s Hospital, Vancouver, British Columbia, Canada (P.B., J.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Zahn","sequence":"additional","affiliation":[{"name":"Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.921692"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.06.001"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.05.051"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.acvd.2014.07.045"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezr130"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26620"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26315"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.10.041"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.27581"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2020.06.039"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2023.03.002"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.30916"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-18-00299"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.30968"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2024.07.036"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs255"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.124.014381"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/HAE.0000000000000084"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccas.2024.102500"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.31427"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccas.2024.102836"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.31147"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.02.038"}],"container-title":["Circulation: Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCINTERVENTIONS.125.015873","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T18:00:44Z","timestamp":1778090444000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCINTERVENTIONS.125.015873"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":23,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1161\/CIRCINTERVENTIONS.125.015873"],"URL":"https:\/\/doi.org\/10.1161\/circinterventions.125.015873","relation":{},"ISSN":["1941-7640","1941-7632"],"issn-type":[{"value":"1941-7640","type":"print"},{"value":"1941-7632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-07-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}