Risk stratification and clinical outcomes after surgical pulmonary valve replacement

Published on Dec 1, 2018in American Heart Journal4.153
· DOI :10.1016/J.AHJ.2018.09.012
Alexander C. Egbe20
Estimated H-index: 20
(Mayo Clinic),
William R. Miranda14
Estimated H-index: 14
(Mayo Clinic)
+ 5 AuthorsHeidi M. Connolly75
Estimated H-index: 75
(Mayo Clinic)
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 ( M ayo A dult C ongenital H eart D isease) 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/m 2 vs 1 91 [179–208], P 2 vs 122 [103–136], P 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/m 2 and tricuspid annular plane systolic excursion/RV systolic pressure (TAPSE/RVSP) 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.
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