Early versus late functional outcome after successful percutaneous pulmonary valve implantation: are the acute effects of altered right ventricular loading all we can expect?

Abstract

OBJECTIVES:

The purpose of this study was to assess the potential of late positive functional remodeling after percutaneous pulmonary valve implantation (PPVI) in right ventricular outflow tract dysfunction.

BACKGROUND:

PPVI has been shown to impact acutely on biventricular function and exercise performance, but the potential for further late functional remodeling remains unknown.

METHODS:

Sixty-five patients with sustained hemodynamic effects of PPVI at 1 year were included. Patients were divided into 2 subgroups based on pre-procedural predominant pulmonary stenosis (PS) (n = 35) or predominant pulmonary regurgitation (PR) (n = 30). Data from magnetic resonance imaging and cardiopulmonary exercise testing were compared at 3 time points: before PPVI, within 1 month (early) and at 12 months (late) after PPVI.

RESULTS:

There was a significant decrease in right ventricle end-diastolic volume early after PPVI in both subgroups of patients. Right ventricle ejection fraction improved early only in the PS group (51 ± 11% vs. 58 ± 11% and 51 ± 12% vs. 50 ± 11%, p < 0.001 for PS, p = 0.13 for PR). Late after intervention, there were no further changes in magnetic resonance parameters in either group (right ventricle ejection fraction, 58 ± 11% in the PS group and 52 ± 11% in the PR group, p = 1.00 and p = 0.13, respectively). In the PS group at cardiopulmonary exercise testing, there was a significant improvement in peak oxygen uptake early (24 ± 8 ml/kg/min vs. 27 ± 9 ml/kg/min, p = 0.008), with no further significant change late (27 ± 9 ml/kg/min, p = 1.00). In the PR group, no significant changes in peak oxygen uptake from early to late could be demonstrated (25 ± 8 ml/kg/min vs. 25 ± 8 ml/kg/min vs. 26 ± 9 ml/kg/min, p = 0.48).

CONCLUSIONS:

In patients with a sustained hemodynamic result 1 year after PPVI, a prolonged phase of maintained cardiac function is observed. However, there is no evidence for further positive functional remodeling beyond the acute effects of PPVI.

• Authors: Philipp Lurz, Johannes Nordmeyer, Alessandro Giardini, Sachin Khambadkone, Vivek Muthurangu, Silvia Schievano, Jean-Benoit Thambo, Fiona Walker, Seamus Cullen, Graham Derrick, Andrew M Taylor, Philipp Bonhoeffer
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 57 Issue 6 Pg. 724-31 (Feb 08 2011) ISSN: 1558-3597 [Electronic] United States
• PMID: 21292132 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Echocardiography
• Exercise Test
• Female
• Follow-Up Studies
• Heart Valve Prosthesis Implantation
• Hemodynamics
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Prospective Studies
• Pulmonary Valve Insufficiency (surgery)
• Ventricular Function
• Young Adult