Risk stratification and clinical outcomes after surgical pulmonary valve replacement.

Abstract

BACKGROUND:

To determine if RV volume was predictive of survival and cardiovascular adverse event (CAE) after pulmonary valve replacement (PVR).

METHODS:

We reviewed the MACHD (Mayo Adult Congenital Heart Disease) database for patients with tetralogy of Fallot (TOF) undergoing PVR, 2000-2015. The patients were divided into quartiles based on RV end-diastolic volume index (RVEDVI); those in the lowest quartile (Group A, n = 46) and the top quartile (Group B, n = 42) were selected as the study cohort.

RESULTS:

In comparison to Group A, Group B patients were older at time of PVR (28 ± 4 vs 33 ± 5 years, P = .011) and had larger RV volumes (RVEDVI 127 [117-138] mL/m2 vs 1 91 [179-208], P < .001; RVESVI 64 [57-73] mL/m2 vs 122 [103-136], P < .001). A total of 28 CAE occurred in 23 patients during 69 (33-94) months follow-up: death (n = 4), heart transplant listing (n = 1), initiation of palliative care (n = 1), heart failure hospitalization (n = 11), stroke (n = 2) and sustained ventricular tachycardia/aborted sudden cardiac death (n = 9). Survival was similar between Groups A and B (95% vs 91% at 10 years, P = .273) but freedom from CAE was significantly lower in Group B (67% vs 36% at 10 years, P = .002). Combination of RVESVI: >95 mL/m2 and tricuspid annular plane systolic excursion/RV systolic pressure (TAPSE/RVSP) <0.4 predicted CAE with sensitivity of 67% and specificity of 92%.

CONCLUSION:

Patients undergoing PVR at larger RV volumes had similar survival but more overall CAE. A larger study population with a longer follow-up will be required to determine if early PVR provides survival benefit in the long-term.

• Authors: Alexander C Egbe, William R Miranda, Sameh M Said, Sorin V Pislaru, Patricia A Pellikka, Barry A Borlaug, Srikanth Kothapalli, Heidi M Connolly
• Journal: American heart journal (Am Heart J) Vol. 206 Pg. 105-112 (12 2018) ISSN: 1097-6744 [Electronic] United States
• PMID: 30343246 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Topics

• Adult
• Echocardiography
• Female
• Follow-Up Studies
• Heart Valve Prosthesis Implantation (methods)
• Heart Ventricles (physiopathology)
• Humans
• Magnetic Resonance Imaging, Cine
• Male
• Pulmonary Valve (diagnostic imaging, surgery)
• Pulmonary Valve Insufficiency (diagnosis, etiology, surgery)
• Retrospective Studies
• Stroke Volume (physiology)
• Tetralogy of Fallot (complications, diagnosis, physiopathology)
• Time Factors
• Treatment Outcome
• Ventricular Function, Right (physiology)