A Low Residual Pressure Gradient Yields Excellent Long-Term Outcome After Percutaneous Pulmonary Valve Implantation.

Georgiev, Stanimir; Ewert, Peter; Tanase, Daniel; Hess, John; Hager, Alfred; Cleuziou, Julie; Meierhofer, Christian; Eicken, Andreas

doi:10.1016/j.jcin.2019.03.037

journal article

Dokumenttyp:: Article; Journal Article
Autor(en):: Georgiev, Stanimir; Ewert, Peter; Tanase, Daniel; Hess, John; Hager, Alfred; Cleuziou, Julie; Meierhofer, Christian; Eicken, Andreas
Titel:: A Low Residual Pressure Gradient Yields Excellent Long-Term Outcome After Percutaneous Pulmonary Valve Implantation.
Abstract:: OBJECTIVES: The aim of this study was to report long-term outcomes after percutaneous pulmonary valve implantation (PPVI). BACKGROUND: Excellent short- and mid-term results after PPVI for right ventricular outflow tract (RVOT) dysfunction have been reported. Data on long-term results after PPVI are scarce. METHODS: All 226 patients treated with PPVI at a single institution were prospectively enrolled in a database and included in the study. Follow-up information regarding outcomes was collected. Risk-factor analysis for death and reinterventions was performed. RESULTS: Follow-up data (up to 11 years) were available in 96% of the patients. At the end of the study period, 219 patients (92.8%) still lived with the initially implanted valve. Seven patients died, 2 of them from procedure-related complications. Seventeen patients (7.2%) needed valve replacement surgically (n = 11) or percutaneously (n = 6) for infectious endocarditis (n = 10) or valve degeneration (n = 7). In the remaining patients, the valves retained excellent function, and right ventricular dimensions and exercise capacity improved. A post-interventional RVOT gradient >15 mm Hg was a risk factor for death (hazard ratio: 7.57; 95% confidence interval: 1.26 to 45.38; p = 0.027) and for valve failure (hazard ratio: 3.76; 95% confidence interval: 1.43 to 9.93; p = 0.007). The best outcome was achieved with RVOT pre-stenting and a post-interventional gradient <15 mm Hg, resulting in an estimated event-free survival rate of 88% at 10 years. CONCLUSIONS: Patients after PPVI have excellent long-term outcomes. Right ventricular volumes, function, and exercise capacity improve significantly. A residual RVOT gradient <15 mm Hg was associated with the best outcome.
Zeitschriftentitel:: JACC Cardiovasc Interv
Jahr:: 2019
Band / Volume:: 12
Heft / Issue:: 16
Seitenangaben Beitrag:: 1594-1603
Volltext / DOI:: doi:10.1016/j.jcin.2019.03.037
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/31202951
Print-ISSN:: 1936-8798
TUM Einrichtung:: Klinik für Kinderkardiologie und angeborene Herzfehler (Prof. Hess)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Kinderkardiologie und angeborene Herzfehler (DHM) (Prof. Ewert)2019