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

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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; Weismann, Constance G.

In: Congenital Heart Disease, Vol. 13, No. 1, 01.2018, p. 140-146.

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Li, Wendy F ; Pollard, Heidi ; Karimi, Mohsen ; Asnes, Jeremy D ; Hellenbrand, William E ; Shabanova, Veronika ; Weismann, Constance G. / Comparison of valvar and right ventricular function following transcatheter and surgical pulmonary valve replacement. In: Congenital Heart Disease. 2018 ; Vol. 13, No. 1. pp. 140-146.

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TY - JOUR

T1 - Comparison of valvar and right ventricular function following transcatheter and surgical pulmonary valve replacement

AU - Li, Wendy F

AU - Pollard, Heidi

AU - Karimi, Mohsen

AU - Asnes, Jeremy D

AU - Hellenbrand, William E

AU - Shabanova, Veronika

AU - Weismann, Constance G

N1 - © 2017 Wiley Periodicals, Inc.

PY - 2018/1

Y1 - 2018/1

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Bioprosthesis

KW - Cardiac Catheterization/methods

KW - Child

KW - Child, Preschool

KW - Echocardiography

KW - Female

KW - Follow-Up Studies

KW - Heart Valve Prosthesis Implantation/methods

KW - Heart Ventricles/diagnostic imaging

KW - Humans

KW - Male

KW - Middle Aged

KW - Pulmonary Valve/diagnostic imaging

KW - Pulmonary Valve Insufficiency/diagnosis

KW - Retrospective Studies

KW - Time Factors

KW - Treatment Outcome

KW - Ventricular Function, Right/physiology

KW - Ventricular Remodeling/physiology

KW - Young Adult

U2 - 10.1111/chd.12544

DO - 10.1111/chd.12544

M3 - Article

VL - 13

SP - 140

EP - 146

JO - Congenital Heart Disease

T2 - Congenital Heart Disease

JF - Congenital Heart Disease

SN - 1747-079X

IS - 1

ER -