Comparison of valvar and right ventricular function following transcatheter and surgical pulmonary valve replacement

Research output: Contribution to journalArticle

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 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.

Details

Authors
  • Wendy F Li
  • Heidi Pollard
  • Mohsen Karimi
  • Jeremy D Asnes
  • William E Hellenbrand
  • Veronika Shabanova
  • Constance G Weismann
External organisations
  • Yale University
  • Yale New Haven Children's Hospital
  • Skåne University Hospital
Research areas and keywords

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
Original languageEnglish
Pages (from-to)140-146
JournalCongenital Heart Disease
Volume13
Issue number1
Publication statusPublished - 2018 Jan
Publication categoryResearch
Peer-reviewedYes
Externally publishedYes