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Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement.
J Am Coll Cardiol. 2012 Sep 11; 60(11):1005-14.JACC

Abstract

OBJECTIVES

The objectives of this study were to evaluate outcomes of pulmonary valve replacement (PVR) in patients with chronic pulmonary regurgitation (PR) and to better define the optimal timing of PVR.

BACKGROUND

Although PVR is effective in reducing right ventricular (RV) volume overload in patients with chronic PR, the optimal timing of PVR is not well defined.

METHODS

A total of 170 patients who underwent PVR between January 1998 and March 2011 for chronic PR were retrospectively analyzed. To define the optimal timing of PVR, pre-operative and post-operative cardiac magnetic resonance imaging (MRI) data (n = 67) were analyzed.

RESULTS

The median age at the time of PVR was 16.7 years. Follow-up completeness was 95%, and the median follow-up duration was 5.9 years. Overall and event-free survival at 10 years was 98% and 70%, respectively. Post-operative MRI showed significant reduction in RV volumes and significant improvement in biventricular function. Receiver-operating characteristic curve analysis revealed a cutoff value of 168 ml/m(2) for non-normalization of RV end-diastolic volume index (EDVI) and 80 ml/m(2) for RV end-systolic volume index (ESVI). Cutoff values for optimal outcome (normalized RV volumes and function) were 163 ml/m(2) for RV EDVI and 80 ml/m(2) for RV ESVI. Higher pre-operative RV ESVI was identified as a sole independent risk factor for suboptimal outcome.

CONCLUSIONS

Midterm outcomes of PVR in patients with chronic PR were acceptable. PVR should be considered before RV EDVI exceeds 163 ml/m(2) or RV ESVI exceeds 80 ml/m(2), with more attention to RV ESVI.

Authors+Show Affiliations

Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22921969

Citation

Lee, Cheul, et al. "Outcomes of Pulmonary Valve Replacement in 170 Patients With Chronic Pulmonary Regurgitation After Relief of Right Ventricular Outflow Tract Obstruction: Implications for Optimal Timing of Pulmonary Valve Replacement." Journal of the American College of Cardiology, vol. 60, no. 11, 2012, pp. 1005-14.
Lee C, Kim YM, Lee CH, et al. Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement. J Am Coll Cardiol. 2012;60(11):1005-14.
Lee, C., Kim, Y. M., Lee, C. H., Kwak, J. G., Park, C. S., Song, J. Y., Shim, W. S., Choi, E. Y., Lee, S. Y., & Baek, J. S. (2012). Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement. Journal of the American College of Cardiology, 60(11), 1005-14. https://doi.org/10.1016/j.jacc.2012.03.077
Lee C, et al. Outcomes of Pulmonary Valve Replacement in 170 Patients With Chronic Pulmonary Regurgitation After Relief of Right Ventricular Outflow Tract Obstruction: Implications for Optimal Timing of Pulmonary Valve Replacement. J Am Coll Cardiol. 2012 Sep 11;60(11):1005-14. PubMed PMID: 22921969.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement. AU - Lee,Cheul, AU - Kim,Yang Min, AU - Lee,Chang-Ha, AU - Kwak,Jae Gun, AU - Park,Chun Soo, AU - Song,Jin Young, AU - Shim,Woo-Sup, AU - Choi,Eun Young, AU - Lee,Sang Yun, AU - Baek,Jae Suk, Y1 - 2012/08/22/ PY - 2011/12/08/received PY - 2012/02/28/revised PY - 2012/03/29/accepted PY - 2012/8/28/entrez PY - 2012/8/28/pubmed PY - 2012/11/14/medline SP - 1005 EP - 14 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 60 IS - 11 N2 - OBJECTIVES: The objectives of this study were to evaluate outcomes of pulmonary valve replacement (PVR) in patients with chronic pulmonary regurgitation (PR) and to better define the optimal timing of PVR. BACKGROUND: Although PVR is effective in reducing right ventricular (RV) volume overload in patients with chronic PR, the optimal timing of PVR is not well defined. METHODS: A total of 170 patients who underwent PVR between January 1998 and March 2011 for chronic PR were retrospectively analyzed. To define the optimal timing of PVR, pre-operative and post-operative cardiac magnetic resonance imaging (MRI) data (n = 67) were analyzed. RESULTS: The median age at the time of PVR was 16.7 years. Follow-up completeness was 95%, and the median follow-up duration was 5.9 years. Overall and event-free survival at 10 years was 98% and 70%, respectively. Post-operative MRI showed significant reduction in RV volumes and significant improvement in biventricular function. Receiver-operating characteristic curve analysis revealed a cutoff value of 168 ml/m(2) for non-normalization of RV end-diastolic volume index (EDVI) and 80 ml/m(2) for RV end-systolic volume index (ESVI). Cutoff values for optimal outcome (normalized RV volumes and function) were 163 ml/m(2) for RV EDVI and 80 ml/m(2) for RV ESVI. Higher pre-operative RV ESVI was identified as a sole independent risk factor for suboptimal outcome. CONCLUSIONS: Midterm outcomes of PVR in patients with chronic PR were acceptable. PVR should be considered before RV EDVI exceeds 163 ml/m(2) or RV ESVI exceeds 80 ml/m(2), with more attention to RV ESVI. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/22921969/Outcomes_of_pulmonary_valve_replacement_in_170_patients_with_chronic_pulmonary_regurgitation_after_relief_of_right_ventricular_outflow_tract_obstruction:_implications_for_optimal_timing_of_pulmonary_valve_replacement_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(12)02325-X DB - PRIME DP - Unbound Medicine ER -