Tags

Type your tag names separated by a space and hit enter

Risk stratification and clinical outcomes after surgical pulmonary valve replacement.
Am Heart J 2018; 206:105-112AH

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+Show Affiliations

The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Electronic address: egbe.alexander@mayo.edu.The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30343246

Citation

Egbe, Alexander C., et al. "Risk Stratification and Clinical Outcomes After Surgical Pulmonary Valve Replacement." American Heart Journal, vol. 206, 2018, pp. 105-112.
Egbe AC, Miranda WR, Said SM, et al. Risk stratification and clinical outcomes after surgical pulmonary valve replacement. Am Heart J. 2018;206:105-112.
Egbe, A. C., Miranda, W. R., Said, S. M., Pislaru, S. V., Pellikka, P. A., Borlaug, B. A., ... Connolly, H. M. (2018). Risk stratification and clinical outcomes after surgical pulmonary valve replacement. American Heart Journal, 206, pp. 105-112. doi:10.1016/j.ahj.2018.09.012.
Egbe AC, et al. Risk Stratification and Clinical Outcomes After Surgical Pulmonary Valve Replacement. Am Heart J. 2018;206:105-112. PubMed PMID: 30343246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk stratification and clinical outcomes after surgical pulmonary valve replacement. AU - Egbe,Alexander C, AU - Miranda,William R, AU - Said,Sameh M, AU - Pislaru,Sorin V, AU - Pellikka,Patricia A, AU - Borlaug,Barry A, AU - Kothapalli,Srikanth, AU - Connolly,Heidi M, Y1 - 2018/09/29/ PY - 2018/03/20/received PY - 2018/09/22/accepted PY - 2018/10/22/pubmed PY - 2019/6/25/medline PY - 2018/10/22/entrez SP - 105 EP - 112 JF - American heart journal JO - Am. Heart J. VL - 206 N2 - 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. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/30343246/Risk_stratification_and_clinical_outcomes_after_surgical_pulmonary_valve_replacement L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(18)30281-3 DB - PRIME DP - Unbound Medicine ER -