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

Wendy F Li; Heidi Pollard; Mohsen Karimi; Jeremy D Asnes; William E Hellenbrand; Veronika Shabanova; Constance G Weismann

doi:10.1111/chd.12544

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

Journal article

Peer reviewed

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

Wendy F Li, Heidi Pollard, Mohsen Karimi, Jeremy D Asnes, William E Hellenbrand, Veronika Shabanova and Constance G Weismann

Congenital heart disease, Vol.13(1), pp.140-146

01/2018

DOI: 10.1111/chd.12544

PMCID: PMC5796854

PMID: 29148206

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https://www.ncbi.nlm.nih.gov/pmc/articles/5796854View

Open Access

Abstract

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. Retrospective review of echocardiograms obtained at three time points: before, immediately after PVR, and most recent. 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. Pulmonary valve and right ventricular function before, immediately after, and most recently after PVR. 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. 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.

Adolescent

Adult

Bioprosthesis

Cardiac Catheterization - methods

Child

Child, Preschool

Echocardiography

Female

Follow-Up Studies

Heart Valve Prosthesis Implantation - methods

Heart Ventricles - diagnostic imaging

Heart Ventricles - physiopathology

Humans

Male

Middle Aged

Pulmonary Valve - diagnostic imaging

Pulmonary Valve - physiopathology

Pulmonary Valve - surgery

Pulmonary Valve Insufficiency - diagnosis

Pulmonary Valve Insufficiency - physiopathology

Pulmonary Valve Insufficiency - surgery

Retrospective Studies

Time Factors

Treatment Outcome

Ventricular Function, Right - physiology

Ventricular Remodeling - physiology

Young Adult

Details

Title: Subtitle: Comparison of valvar and right ventricular function following transcatheter and surgical pulmonary valve replacement
Creators: Wendy F Li - Yale University
Heidi Pollard - Pediatric Echocardiography Laboratory, Yale New Haven Children's Hospital, New Haven, CT, USA
Mohsen Karimi - Yale University
Jeremy D Asnes - Yale University
William E Hellenbrand - Yale University
Veronika Shabanova - Yale University
Constance G Weismann - Yale University
Resource Type: Journal article
Publication Details: Congenital heart disease, Vol.13(1), pp.140-146
DOI: 10.1111/chd.12544
PMID: 29148206
PMCID: PMC5796854
NLM abbreviation: Congenit Heart Dis
ISSN: 1747-079X
eISSN: 1747-0803
Grant note: T35 HL007649 / NHLBI NIH HHS UL1 TR001863 / NCATS NIH HHS
Language: English
Date published: 01/2018
Academic Unit: Cardiothoracic Surgery
Record Identifier: 9984557948302771

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15 Times Cited - Web of Science