TY - EJOU
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.
TI - Comparison of valvar and right ventricular function following transcatheter and surgical pulmonary valve replacement
T2 - Congenital Heart Disease
PY - 2018
VL - 13
IS - 1
SN - 1747-0803
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 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.
KW - echocardiography
KW - melody valve
KW - pulmonary valve replacement
KW - right ventricular function
KW - surgical
KW - transcatheter
DO - 10.1111/chd.12544