Comparison of valvar and right ventricular function following transcatheter and surgical pulmonary valve replacement
Li, Wendy F ; Pollard, Heidi ; Karimi, Mohsen ; Asnes, Jeremy D ; Hellenbrand, William E ; Shabanova, Veronika and Weismann, Constance G LU
(2018)
In Congenital Heart Disease
13(1).
p.140-146
- Abstract
OBJECTIVE: Trans-catheter (TC) pulmonary valve replacement (PVR) has become common practice for patients with right ventricular outflow tract obstruction (RVOTO) and/or pulmonic insufficiency (PI). Our aim was to compare PVR and right ventricular (RV) function of patients who received TC vs surgical PVR.
DESIGN: Retrospective review of echocardiograms obtained at three time points: before, immediately after PVR, and most recent.
PATIENTS: Sixty-two patients (median age 19 years, median follow-up 25 months) following TC (N = 32) or surgical (N = 30) PVR at Yale-New Haven Hospital were included.
OUTCOME MEASURES: Pulmonary valve and right ventricular function before, immediately after, and most recently after... (More)
OBJECTIVE: Trans-catheter (TC) pulmonary valve replacement (PVR) has become common practice for patients with right ventricular outflow tract obstruction (RVOTO) and/or pulmonic insufficiency (PI). Our aim was to compare PVR and right ventricular (RV) function of patients who received TC vs surgical PVR.
DESIGN: Retrospective review of echocardiograms obtained at three time points: before, immediately after PVR, and most recent.
PATIENTS: Sixty-two patients (median age 19 years, median follow-up 25 months) following TC (N = 32) or surgical (N = 30) PVR at Yale-New Haven Hospital were included.
OUTCOME MEASURES: Pulmonary valve and right ventricular function before, immediately after, and most recently after PVR.
RESULTS: At baseline, the TC group had predominant RVOTO (74% vs 10%, P < .001), and moderate-severe PI was less common (61% vs 100%, P < .001). Immediate post-procedural PVR function was good throughout. At last follow-up, the TC group had preserved valve function, but the surgical group did not (moderate RVOTO: 6% vs 41%, P < .001; >mild PI: 0% vs 24%, P = .003). Patients younger than 17 years at surgical PVR had the highest risk of developing PVR dysfunction, while PVR function in follow-up was similar in adults. Looking at RV size and function, both groups had a decline in RV size following PVR. However, while RV function remained stable in the TC group, there was a transient postoperative decline in the surgical group.
CONCLUSIONS: TC PVR in patients age <17 years is associated with better PVR function in follow-up compared to surgical valves. There was a transient decline in RV function following surgical but not TC PVR. TC PVR should therefore be the first choice in children who are considered for PVR, whenever possible.
(Less)
- author
- Li, Wendy F
; Pollard, Heidi
; Karimi, Mohsen
; Asnes, Jeremy D
; Hellenbrand, William E
; Shabanova, Veronika
and Weismann, Constance G
LU
- publishing date
- 2018-01
- type
- Contribution to journal
- publication status
- published
- keywords
- Adolescent, Adult, Bioprosthesis, Cardiac Catheterization/methods, Child, Child, Preschool, Echocardiography, Female, Follow-Up Studies, Heart Valve Prosthesis Implantation/methods, Heart Ventricles/diagnostic imaging, Humans, Male, Middle Aged, Pulmonary Valve/diagnostic imaging, Pulmonary Valve Insufficiency/diagnosis, Retrospective Studies, Time Factors, Treatment Outcome, Ventricular Function, Right/physiology, Ventricular Remodeling/physiology, Young Adult
- in
- Congenital Heart Disease
- volume
- 13
- issue
- 1
- pages
- 140 - 146
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85034267478
- pmid:29148206
- ISSN
- 1747-079X
- DOI
- 10.1111/chd.12544
- language
- English
- LU publication?
- no
- id
- b0e5cc9b-f670-4cd2-bb3b-393d5434150c
- date added to LUP
- 2019-01-25 14:40:35
- date last changed
- 2024-04-15 21:31:09
@article{b0e5cc9b-f670-4cd2-bb3b-393d5434150c,
abstract = {{<p>OBJECTIVE: Trans-catheter (TC) pulmonary valve replacement (PVR) has become common practice for patients with right ventricular outflow tract obstruction (RVOTO) and/or pulmonic insufficiency (PI). Our aim was to compare PVR and right ventricular (RV) function of patients who received TC vs surgical PVR.</p><p>DESIGN: Retrospective review of echocardiograms obtained at three time points: before, immediately after PVR, and most recent.</p><p>PATIENTS: Sixty-two patients (median age 19 years, median follow-up 25 months) following TC (N = 32) or surgical (N = 30) PVR at Yale-New Haven Hospital were included.</p><p>OUTCOME MEASURES: Pulmonary valve and right ventricular function before, immediately after, and most recently after PVR.</p><p>RESULTS: At baseline, the TC group had predominant RVOTO (74% vs 10%, P < .001), and moderate-severe PI was less common (61% vs 100%, P < .001). Immediate post-procedural PVR function was good throughout. At last follow-up, the TC group had preserved valve function, but the surgical group did not (moderate RVOTO: 6% vs 41%, P < .001; >mild PI: 0% vs 24%, P = .003). Patients younger than 17 years at surgical PVR had the highest risk of developing PVR dysfunction, while PVR function in follow-up was similar in adults. Looking at RV size and function, both groups had a decline in RV size following PVR. However, while RV function remained stable in the TC group, there was a transient postoperative decline in the surgical group.</p><p>CONCLUSIONS: TC PVR in patients age <17 years is associated with better PVR function in follow-up compared to surgical valves. There was a transient decline in RV function following surgical but not TC PVR. TC PVR should therefore be the first choice in children who are considered for PVR, whenever possible.</p>}},
author = {{Li, Wendy F and Pollard, Heidi and Karimi, Mohsen and Asnes, Jeremy D and Hellenbrand, William E and Shabanova, Veronika and Weismann, Constance G}},
issn = {{1747-079X}},
keywords = {{Adolescent; Adult; Bioprosthesis; Cardiac Catheterization/methods; Child; Child, Preschool; Echocardiography; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation/methods; Heart Ventricles/diagnostic imaging; Humans; Male; Middle Aged; Pulmonary Valve/diagnostic imaging; Pulmonary Valve Insufficiency/diagnosis; Retrospective Studies; Time Factors; Treatment Outcome; Ventricular Function, Right/physiology; Ventricular Remodeling/physiology; Young Adult}},
language = {{eng}},
number = {{1}},
pages = {{140--146}},
publisher = {{Wiley-Blackwell}},
series = {{Congenital Heart Disease}},
title = {{Comparison of valvar and right ventricular function following transcatheter and surgical pulmonary valve replacement}},
url = {{http://dx.doi.org/10.1111/chd.12544}},
doi = {{10.1111/chd.12544}},
volume = {{13}},
year = {{2018}},
}