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

Li, Wendy F.; Pollard, H. Marvin; Karimi, Mohsen; Asnes, Jeremy D.; Hellenbrand, William E.; Shabanova, Veronika; Weismann, Constance G.

doi:10.1111/chd.12544

Cited by 16 publications

(8 citation statements)

References 29 publications

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“…Most of the literature on the optimal timing of PVR dates to an era before TC‐PVR was an option. With growing adoption and improved operator skills associated with transcatheter techniques, it remains less clear whether the timing for TC‐PVR should adhere to guidelines based on these older studies from a S‐PVR cohort . Future studies should seek to explore atrial sizes and remodeling after transcatheter PVR in greater detail, and whether atrial chamber dimensions might also contribute to guide decision making for optimal timing of intervention to reduce the burden of atrial arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative and short‐term atrial tachyarrhythmia burdens after transcatheter vs surgical pulmonary valve replacement among congenital heart disease patients

Wadia¹,

Lluri²,

Aboulhosn³

et al. 2019

Congenital Heart Disease

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Objective We examined the atrial tachyarrhythmia (AT) burden among patients with congenital heart disease (CHD) following transcatheter (TC‐) or surgical (S‐) pulmonary valve replacement (PVR). Design/Setting This was a retrospective observational study of patients who underwent PVR from 2010 to 2016 at UCLA Medical Center. Patients Patients of all ages who had prior surgical repair for CHD were included. Patients with a history of congenitally corrected transposition of the great arteries, underwent a hybrid PVR procedure, or had permanent atrial fibrillation (AF) without a concomitant ablation were excluded. Outcome Measures The primary outcome was a time‐to‐event analysis of sustained AT. Sustained ATs were defined as focal AT, intra‐atrial reentrant tachycardia/atrial flutter, or AF lasting at least 30 seconds or terminating with cardioversion or antitachycardia pacing. Results Two hundred ninety‐seven patients (TC‐PVR, n = 168 and S‐PVR, n = 129) were included. During a median follow‐up of 1.2 years, nine events occurred in TC‐PVR group (5%) vs 23 events in S‐PVR group (18%). In the propensity adjusted models, the following factors were associated with significant risk of AT after PVR: history of AT, age at valve implantation, severe right atrial enlargement, and S‐PVR. In the secondary analysis, TC‐PVR was associated with lower adjusted risk of AT events in the postoperative epoch (first 30 days), adjusted IRR 0.31 (0.14‐0.97), P = .03, but similar risk in the short‐term epoch, adjusted IRR 0.64 (0.14‐2.94), P = .57. Conclusion There was an increased risk of AT in the first 30 days following S‐PVR compared to TC‐PVR. Additional factors associated with risk of AT events after PVR were a history of AT, age at valve implantation, and severe right atrial enlargement.

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Section: Discussionmentioning

confidence: 99%

“…20,21 The consequent stress a S-PVR cohort. [22][23][24][25][26] Future studies should seek to explore atrial sizes and remodeling after transcatheter PVR in greater detail, and whether atrial chamber dimensions might also contribute to guide decision making for optimal timing of intervention to reduce the burden of atrial arrhythmias.…”

Section: Re Sultsmentioning

confidence: 99%

Postoperative and short‐term atrial tachyarrhythmia burdens after transcatheter vs surgical pulmonary valve replacement among congenital heart disease patients

Wadia¹,

Lluri²,

Aboulhosn³

et al. 2019

Congenital Heart Disease

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“…If reconstruction of the pulmonary artery branches, or closure of residual intra-cardiac defects, or remodeling of a hugely dilated right ventricle, are required in association with the PV implantation, and these cannot be accomplished by a procedure of interventional cardiology, then the indication is given for surgical implantation of a PV or a right-ventricle to pulmonary artery valved conduit ( 7 , 9 , 11 – 18 , 39 – 44 ).…”

Section: Choice Of the Approach: Percutaneous Interventional Vs Surgmentioning

confidence: 99%

“…With regard to the need for a PV implantation in the presence of severe PV regurgitation, extensive debates accompany the following issues: timing of PV implantation, particularly in asymptomatic patients ( 5 – 7 , 9 , 13 – 24 ) choice of the approach, percutaneous interventional ( 5 , 25 – 38 ) vs. surgical ( 7 , 9 , 11 – 18 , 39 – 44 ) PV implantation choice of the most suitable valve ( 2 , 39 – 43 , 45 – 53 ). …”

Section: Introductionmentioning

confidence: 99%

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Pulmonary Valve Regurgitation: Neither Interventional Nor Surgery Fits All

Corno

2018

Front. Pediatr.

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Introduction: PV implantation is indicated for severe PV regurgitation after surgery for congenital heart defects, but debates accompany the following issues: timing of PV implantation; choice of the approach, percutaneous interventional vs. surgical PV implantation, and choice of the most suitable valve.Timing of pulmonary valve implantation: The presence of symptoms is class I evidence indication for PV implantation. In asymptomatic patients indication is agreed for any of the following criteria: PV regurgitation > 20%, indexed end-diastolic right ventricular volume > 120–150 ml/m2 BSA, and indexed end-systolic right ventricular volume > 80–90 ml/m2 BSA.Choice of the approach: percutaneous interventional vs. surgical: The choice of the approach depends upon the morphology and the size of the right ventricular outflow tract, the morphology and the size of the pulmonary arteries, the presence of residual intra-cardiac defects and the presence of extremely dilated right ventricle.Choice of the most suitable valve for surgical implantation: Biological valves are first choice in most of the reported studies. A relatively large size of the biological prosthesis presents the advantage of avoiding a right ventricular outflow tract obstruction, and also of allowing for future percutaneous valve-in-valve implantation. Alternatively, biological valved conduits can be implanted between the right ventricle and pulmonary artery, particularly when a reconstruction of the main pulmonary artery and/or its branches is required.Hybrid options: combination of interventional and surgical: Many progresses extended the implantation of a PV with combined hybrid interventional and surgical approaches. Major efforts have been made to overcome the current limits of percutaneous PV implantation, namely the excessive size of a dilated right ventricular outflow tract and the absence of a cylindrical geometry of the right ventricular outflow tract as a suitable landing for a percutaneous PV implantation.Conclusion: Despite tremendous progress obtained with modern technologies, and the endless fantasy of researchers trying to explore new forms of treatment, it is too early to say that either the interventional or the surgical approach to implant a PV can fit all patients with good long-term results.

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