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

Wendy F. Li1, Heidi Pollard2, Mohsen Karimi3, Jeremy D. Asnes1, William E. Hellenbrand1, Veronika Shabanova4, Constance G. Weismann1,5
1 Department of Pediatrics, Division of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA
2 Pediatric Echocardiography Laboratory, Yale New Haven Children’s Hospital, New Haven, CT, USA
3 Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
4 Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
5 Department of Pediatric Surgery, Division of Pediatric Cardiology, Pediatric Heart Center, Skåne Universitetssjukhus, Lund, Sweden
* Corresponding Author: Constance G. Weismann, MD, Pediatric Heart Center, Skåne Universitetssjukhus, Lasarettgatan 48, 22241 Lund, Sweden. Email:

Congenital Heart Disease 2018, 13(1), 140-146. https://doi.org/10.1111/chd.12544

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 followup 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

echocardiography, melody valve, pulmonary valve replacement, right ventricular function, surgical, transcatheter

Cite This Article

Li, W. F., Pollard, H., Karimi, M., Asnes, J. D., Hellenbrand, W. E. et al. (2018). Comparison of valvar and right ventricular function following transcatheter and surgical pulmonary valve replacement. Congenital Heart Disease, 13(1), 140–146.



This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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