Long-term Follow-up of Patients After Surgical Treatment for Isolated Pulmonary Valve Stenosis (original) (raw)
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Long-term outcome after treatment of isolated pulmonary valve stenosis
International Journal of Cardiology, 2012
Background: Few data are available on very long-term follow-up after treatment for isolated pulmonary valve stenosis (PVS), either surgically or by percutaneous balloon angioplasty (PBA). Methods and results: All patients with isolated PVS were selected from our database of congenital heart defects. Their records were reviewed systematically. We identified 79 surgically treated patients with a median follow-up of 22.5 years (range 0-45 years) and 139 PBA patients with median follow-up of 6.0 years (range 0-21 years). Echocardiographic and catheterization parameters indicate excellent results of both techniques in relieving the transpulmonary gradient. However, after initial surgery 20.3% of patients needed a cardiac re-intervention: 81% for severe pulmonary valve regurgitation, but none for residual pulmonary stenosis. After initial PBA a cardiac re-intervention was needed in 9.4% of patients. In 85% the indication was residual pulmonary stenosis, in none of them pulmonary regurgitation, although almost all patients developed a mild pulmonary regurgitation. Freedom of re-intervention after surgery was 98.4%, 93.5%, 87.7%, 70.9% and 55.7% at 5, 10, 20, 30 and 40 years postoperatively. Freedom of re-intervention in the PBA group was 95.1%, 87.5% and 84.4% at 5, 10 and 20 years post-procedure. Conclusions: Both surgery and PBA are safe and successful in relieving the acute transpulmonary gradient. Long-term results of surgery are worse than previously thought due to severe PR. After PBA re-interventions for residual stenosis are frequently needed and the incidence of mild PR is high. Very long-term results of PBA are still unknown.
Long-term survival in patients with isolated pulmonary valve stenosis: a not so benign disease?
Open Heart
Background and objectivesDuring the last decades, the survival rates in patients with congenital heart disease have increased dramatically, particularly in patients with complex heart malformations. However, the survival in patients with simple defects is still unknown. We aimed to determine the characteristics and the risk of mortality in patients with isolated pulmonary valve stenosis (PS).MethodsSwedish inpatient, outpatient and cause of death registries were used to identify patients born between 1970 and 2017 with a diagnosis of PS, without any other concomitant congenital heart lesion. For each patient with PS, 10 control individuals without congenital heart disease were matched by birth year and sex from the total population registry. We used median-unbiased method and Kaplan-Meier survival analysis to examine the risk of mortality.ResultsWe included 3910 patients with PS and 38 770 matched controls. The median age of diagnosis of PS was 0.7 years (IQR 0.3–7.0). During a medi...
Circulation, 2010
Background-Although pulmonary valve replacement (PVR) is effective in reducing right ventricular (RV) volume overload in patients with chronic pulmonary regurgitation (PR), persistent RV dysfunction and subsequent adverse clinical outcomes have been reported. This trial was conducted to investigate whether the addition of surgical RV remodeling with exclusion of scar tissue to PVR would result in improved RV function and laboratory and clinical parameters, as compared with PVR alone. Methods and Results-Between February 2004 and October 2008, 64 patients who underwent RV outflow tract procedures in early childhood, had ≥moderate PR, and fulfilled defined criteria for PVR were randomly assigned to undergo either PVR alone (n = 34) or PVR with surgical RV remodeling (n = 30). No significant difference was observed in the primary outcome (change in RV ejection fraction:-2±7% in the PVR alone group and-1±7% in the PVR with RV remodeling group, P = 0.38) or in any of the secondary outcomes at 6-month postoperative follow-up. Multivariable analysis of the entire cohort identified preoperative RV end-systolic volume index <90 ml/m 2 and QRS duration <140 ms to be associated with optimal postoperative outcome (normal RV size and function), and RV ejection fraction <45% and QRS duration ≥160 ms to be associated with suboptimal postoperative outcome (RV dilatation and dysfunction). Conclusion-The addition of surgical remodeling of the RV to PVR in patients with chronic PR did not result in a measurable early benefit. Referral to PVR based on QRS duration, RV endsystolic volume, or RV ejection fraction may be beneficial.
The Annals of Thoracic Surgery, 2011
Background. Pulmonary valve replacement (PVR) is a common therapy for chronic pulmonary regurgitation. However, the use of this strategy is mostly based on the studies performed on patients with tetralogy of Fallot (TOF) and not in patients with pulmonary atresia/intact ventricular septum (PA/IVS). The aim of this study is to evaluate our experience with PVR in patients with PA/ IVS and compare them with a matched cohort of TOF patients.
Repeat Pulmonary Valve Replacement
JACC: Cardiovascular Interventions, 2018
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 ¼ 36; SPVR, n ¼ 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 bio
Surgical pulmonary valve replacement: A benchmark for outcomes comparisons
The Journal of Thoracic and Cardiovascular Surgery, 2014
Background: Patients with right heart obstructive lesions develop residual or recurrent right ventricle outflow tract pathology as a result of native or implanted pulmonary valve (PV) dysfunction. Until recently, the standard of care has been surgical placement of a PVor valved right ventricle to pulmonary artery conduit. Catheter-based options are being increasingly applied in patients with PV dysfunction. The purpose of our study was to evaluate outcomes of surgical pulmonary valve/conduit replacement (PVR) at a large pediatric hospital to provide contemporary benchmark data for comparison with developing technologies.
Risk Factors for Prosthesis Failure in Pulmonary Valve Replacement
The Annals of Thoracic Surgery, 2011
Background. After initial right ventricular outflow tract reconstruction, replacement of the pulmonary valve (PVR) with a bioprosthetic valve may be performed. Bioprosthetic valves fail (PVF) and require repeat replacement. Identification of risk factors for PVF would be useful for clinicians choosing among various options for the initial PVR.
Journal of the American College of Cardiology, 2012
The objectives of this study were to evaluate outcomes of pulmonary valve replacement (PVR) in patients with chronic pulmonary regurgitation (PR) and to better define the optimal timing of PVR. Background Although PVR is effective in reducing right ventricular (RV) volume overload in patients with chronic PR, the optimal timing of PVR is not well defined. Methods A total of 170 patients who underwent PVR between January 1998 and March 2011 for chronic PR were retrospectively analyzed. To define the optimal timing of PVR, pre-operative and post-operative cardiac magnetic resonance imaging (MRI) data (n ϭ 67) were analyzed. Results The median age at the time of PVR was 16.7 years. Follow-up completeness was 95%, and the median follow-up duration was 5.9 years. Overall and event-free survival at 10 years was 98% and 70%, respectively. Post-operative MRI showed significant reduction in RV volumes and significant improvement in biventricular function. Receiver-operating characteristic curve analysis revealed a cutoff value of 168 ml/m 2 for nonnormalization of RV end-diastolic volume index (EDVI) and 80 ml/m 2 for RV end-systolic volume index (ESVI). Cutoff values for optimal outcome (normalized RV volumes and function) were 163 ml/m 2 for RV EDVI and 80 ml/m 2 for RV ESVI. Higher pre-operative RV ESVI was identified as a sole independent risk factor for suboptimal outcome. Conclusions Midterm outcomes of PVR in patients with chronic PR were acceptable. PVR should be considered before RV EDVI exceeds 163 ml/m 2 or RV ESVI exceeds 80 ml/m 2 , with more attention to RV ESVI.
Isolated pulmonary valve replacement: analysis of 27 years of experience
Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs, 2008
The aim of this study was to investigate the longterm results of isolated pulmonary valve replacement using xenobioprostheses or mechanical valves. Twenty-four cases of isolated pulmonary valve replacement carried out at Kyushu University Hospital between 1977 and 2004 were reviewed. Those undergoing Rastelli's operation were excluded from this study. Bioprostheses were used in 18 patients and mechanical valves in 6. There were no operative deaths. Two patients with mechanical valves needed repeat pulmonary valve replacement due to thrombosed valves. The patients with bioprostheses had no need of repeat replacement postoperatively. The cardiothoracic ratio significantly improved from 60.3% preoperatively to 55.4% postoperatively (P < 0.05), and the New York Heart Association (NYHA) class significantly improved from 2.0 preoperatively to 1.1 postoperatively (P < 0.05). The actuarial survival rate at 15 years was 92.3%. The valve-related event-free ratio at 15 years was 85.7...
Journal of cardiovascular ultrasound, 2013
Isolated pulmonary valve stenosis (PS) makes up 6-9% of all congenital heart defects among children. The initial gold standard for diagnosis, follow-up of PS is by echocardiography. However, the most accurate diagnosis still remains to be measurement of the pressure gradient through transcatheterization. The purpose of this study is to compare the difference between the echocardiographic data to the cardiac catheterization data on the diagnosis, treatment, and follow-up in patients diagnosed as PS, and to see what parameters should be closely monitored. A total of 112 patients (Male : Female = 46 : 66) who underwent balloon pulmonary valvuloplasty (BPV) at Severance Cardiovascular Hospital, between December, 2002 to August, 2012 were retrospectively analyzed. The patients were all under 16 years of age and critical PS patients who underwent BPV were excluded from this study. The pre-BPV right ventricle (RV)-pulmonary artery (PA) systolic pressure gradient and post-BPV systolic press...