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

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@article{b0e5cc9bf6704cd2bb3b393d5434150c,
title = "Comparison of valvar and right ventricular function following transcatheter and surgical pulmonary valve replacement",
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.",
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",
author = "Li, {Wendy F} and Heidi Pollard and Mohsen Karimi and Asnes, {Jeremy D} and Hellenbrand, {William E} and Veronika Shabanova and Weismann, {Constance G}",
note = "{\circledC} 2017 Wiley Periodicals, Inc.",
year = "2018",
month = "1",
doi = "10.1111/chd.12544",
language = "English",
volume = "13",
pages = "140--146",
journal = "Congenital Heart Disease",
issn = "1747-079X",
publisher = "Wiley-Blackwell",
number = "1",

}