Author + information
- Received April 5, 2018
- Revision received July 23, 2018
- Accepted July 25, 2018
- Published online December 17, 2018.
- Hope Caughron, BAa,
- Dennis Kim, MD, PhDa,b,
- Norihiko Kamioka, MDa,
- Stamatios Lerakis, MDa,
- Altayyeb Yousef, MDa,
- Aneesha Mainia,
- Shawn Reginaulda,
- Anurag Sahu, MDa,
- Subhadra Shashidharan, MDc,
- Maan Jokhadar, MDa,
- Fred H. Rodriguez III, MDa,
- Wendy M. Book, MDa,
- Michael McConnell, MDa,
- Peter C. Block, MDa and
- Vasilis Babaliaros, MDa,∗ ()
- aDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- bDivision of Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia
- cDivision of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
- ↵∗Address for correspondence:
Dr. Vasilis Babaliaros, Emory University Hospital F606, 1364 Clifton Road, Atlanta, Georgia 30322.
Objectives This study compares 30-day, 1-year, and 3-year echocardiographic findings and clinical outcomes of transcatheter pulmonary valve-in-valve replacement (TPVR) and repeat surgical pulmonary valve replacement (SPVR).
Background In patients with adult congenital heart disease and previous pulmonary valve replacement (PVR) who require redo PVR, it is unclear whether TPVR or repeat SPVR is the preferred strategy.
Methods We retrospectively identified 66 patients (TPVR, n = 36; SPVR, n = 30) with bioprosthetic pulmonary valves (PVs) who underwent either TPVR or repeat SPVR at Emory Healthcare from January 2007 to August 2017.
Results The TPVR cohort had fewer men and more patients with baseline New York Heart Association (NYHA) functional class III or IV. There was no difference in mortality, cardiovascular readmission, or post-procedural PV reintervention at 30 days, 1 year, or 3 years. Post-procedural echocardiographic findings showed no difference in mean PV gradients between the TPVR and SPVR groups at 30 days, 1 year, or 3 years. In the TPVR cohort, there was less right ventricular dysfunction at 30 days (2.9% vs. 46.7%; p < 0.01), despite higher baseline NYHA functional class in the SPVR cohort.
Conclusions In patients with bioprosthetic PV dysfunction who underwent either TPVR or SPVR, there was no difference in mortality, cardiovascular readmission, or repeat PV intervention at 30 days, 1 year, or 3 years. Additionally, TPVR and SPVR had similar intermediate-term PV longevity, with no difference in PV gradients or PVR. The TPVR cohort also had less right ventricular dysfunction at 30 days despite a higher baseline NYHA functional classification. These intermediate-term results suggest that TPVR may be an attractive alternative to SPVR in patients with previous bioprosthetic surgical PVs.
Dr. Lerakis is a consultant for Edwards Lifesciences and Abbott Vascular. Dr. Babaliaros is a consultant for and received research grant support from Abbott Vascular and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 5, 2018.
- Revision received July 23, 2018.
- Accepted July 25, 2018.
- 2018 American College of Cardiology Foundation
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