Open Access

ARTICLE

Comparison of valvar and right ventricular function following transcatheter and surgical pulmonary valve replacement

by

1 Department of Pediatrics, Division of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA
2 Pediatric Echocardiography Laboratory, Yale New Haven Children’s Hospital, New Haven, CT, USA
3 Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
4 Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
5 Department of Pediatric Surgery, Division of Pediatric Cardiology, Pediatric Heart Center, Skåne Universitetssjukhus, Lund, Sweden

* Corresponding Author: Constance G. Weismann, MD, Pediatric Heart Center, Skåne Universitetssjukhus, Lasarettgatan 48, 22241 Lund, Sweden. Email:

Congenital Heart Disease 2018, 13(1), 140-146. https://doi.org/10.1111/chd.12544

Abstract

Objective: Trans-catheter (TC) pulmonary valve replacement (PVR) has become common practice for patients with right ventricular outflow tract obstruction (RVOTO) and/or pulmonic insufficiency (PI). Our aim was to compare PVR and right ventricular (RV) function of patients who received TC vs surgical PVR.
Design: Retrospective review of echocardiograms obtained at three time points: before, immediately after PVR, and most recent.
Patients: Sixty-two patients (median age 19 years, median follow-up 25 months) following TC (N = 32) or surgical (N = 30) PVR at Yale-New Haven Hospital were included.
Outcome Measures: Pulmonary valve and right ventricular function before, immediately after, and most recently after PVR.
Results: At baseline, the TC group had predominant RVOTO (74% vs 10%, P < .001), and moderate-severe PI was less common (61% vs 100%, P < .001). Immediate post-procedural PVR function was good throughout. At last follow-up, the TC group had preserved valve function, but the surgical group did not (moderate RVOTO: 6% vs 41%, P < .001; >mild PI: 0% vs 24%, P = .003). Patients younger than 17 years at surgical PVR had the highest risk of developing PVR dysfunction, while PVR function in follow-up was similar in adults. Looking at RV size and function, both groups had a decline in RV size following PVR. However, while RV function remained stable in the TC group, there was a transient postoperative decline in the surgical group.
Conclusions: TC PVR in patients age <17 years is associated with better PVR function in followup compared to surgical valves. There was a transient decline in RV function following surgical but not TC PVR. TC PVR should therefore be the first choice in children who are considered for PVR, whenever possible.

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