@Article{chd.12544,
AUTHOR = {Wendy F. Li, Heidi Pollard, Mohsen Karimi, Jeremy D. Asnes, William E. Hellenbrand, Veronika Shabanova, Constance G. Weismann},
TITLE = {Comparison of valvar and right ventricular function following transcatheter and surgical pulmonary valve replacement},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {1},
PAGES = {140--146},
URL = {http://www.techscience.com/schd/v13n1/38946},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> 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.<br/>
<b>Design:</b> Retrospective review of echocardiograms obtained at three time points: before, immediately after PVR, and most recent.<br/>
<b>Patients:</b> 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.<br/>
<b>Outcome Measures:</b> Pulmonary valve and right ventricular function before, immediately after, and
most recently after PVR.<br/>
<b>Results:</b> 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.<br/>
<b>Conclusions:</b> 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.},
DOI = {10.1111/chd.12544}
}