Reintervention and Survival After Transcatheter Pulmonary Valve Replacement.

McElhinney, Doff B; Zhang, Yulin; Levi, Daniel S; Georgiev, Stanimir; Biernacka, Elżbieta Katarzyna; Goldstein, Bryan H; Shahanavaz, Shabana; Qureshi, Athar M; Cabalka, Allison K; Bauser-Heaton, Holly; Torres, Alejandro J; Morray, Brian H; Armstrong, Aimee K; Millan-Iturbe, Oscar; Peng, Lynn F; Aboulhosn, Jamil A; Rużyłło, Witold; Berger, Felix; Sondergaard, Lars; Schranz, Dietmar; Cheatham, John P; Jones, Thomas K; Ewert, Peter; Schubert, Stephan

doi:10.1016/j.jacc.2021.10.031

journal article

Title:: Reintervention and Survival After Transcatheter Pulmonary Valve Replacement.
Document type:: Article; Journal Article
Author(s):: McElhinney, Doff B; Zhang, Yulin; Levi, Daniel S; Georgiev, Stanimir; Biernacka, Elżbieta Katarzyna; Goldstein, Bryan H; Shahanavaz, Shabana; Qureshi, Athar M; Cabalka, Allison K; Bauser-Heaton, Holly; Torres, Alejandro J; Morray, Brian H; Armstrong, Aimee K; Millan-Iturbe, Oscar; Peng, Lynn F; Aboulhosn, Jamil A; Rużyłło, Witold; Berger, Felix; Sondergaard, Lars; Schranz, Dietmar; Cheatham, John P; Jones, Thomas K; Ewert, Peter; Schubert, Stephan
Abstract:: BACKGROUND: Transcatheter pulmonary valve (TPV) replacement (TPVR) has become the standard therapy for postoperative pulmonary outflow tract dysfunction in patients with a prosthetic conduit/valve, but there is limited information about risk factors for death or reintervention after this procedure. OBJECTIVES: This study sought to evaluate mid- and long-term outcomes after TPVR in a large multicenter cohort. METHODS: International registry focused on time-related outcomes after TPVR. RESULTS: Investigators submitted data for 2,476 patients who underwent TPVR and were followed up for 8,475 patient-years. A total of 95 patients died after TPVR, most commonly from heart failure (n = 24). The cumulative incidence of death was 8.9% (95% CI: 6.9%-11.5%) 8 years after TPVR. On multivariable analysis, age at TPVR (HR: 1.04 per year; 95% CI: 1.03-1.06 per year; P < 0.001), a prosthetic valve in other positions (HR: 2.1; 95% CI: 1.2-3.7; P = 0.014), and an existing transvenous pacemaker/implantable cardioverter-defibrillator (HR: 2.1; 95% CI: 1.3-3.4; P = 0.004) were associated with death. A total of 258 patients underwent TPV reintervention. At 8 years, the cumulative incidence of any TPV reintervention was 25.1% (95% CI: 21.8%-28.5%) and of surgical TPV reintervention was 14.4% (95% CI: 11.9%-17.2%). Risk factors for surgical reintervention included age (0.95 per year [95% CI: 0.93-0.97 per year]; P < 0.001), prior endocarditis (2.5 [95% CI: 1.4-4.3]; P = 0.001), TPVR into a stented bioprosthetic valve (1.7 [95% CI: 1.2-2.5]; P = 0.007), and postimplant gradient (1.4 per 10 mm Hg [95% CI: 1.2-1.7 per 10 mm Hg]: P < 0.001). CONCLUSIONS: These findings support the conclusion that survival and freedom from reintervention or surgery after TPVR are generally comparable to outcomes of surgical conduit/valve replacement across a wide age range.
Journal title abbreviation:: J Am Coll Cardiol
Year:: 2022
Journal volume:: 79
Journal issue:: 1
Pages contribution:: 18-32
Fulltext / DOI:: doi:10.1016/j.jacc.2021.10.031
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/34991785
Print-ISSN:: 0735-1097
TUM Institution:: Klinik für Kinderkardiologie und angeborene Herzfehler (Prof. Ewert)
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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)2022