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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.

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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
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
2019-03-19 04:04:32
@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 &lt; .001), and moderate-severe PI was less common (61% vs 100%, P &lt; .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 &lt; .001; &gt;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 &lt;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},
  keyword      = {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},
  volume       = {13},
  year         = {2018},
}