Reintervention and Survival After Transcatheter Pulmonary Valve Replacement

• DOI: 10.1016/j.jacc.2021.10.031
• Publication Date: 2022-01-03T22:47:15Z
• Authors: Doff B. McElhinney; Yulin Zhang; Daniel S. Levi; Stanimir Georgiev; Elżbieta Katarzyn...; Bryan H. Goldstein; Shabana Shahanavaz; Athar M. Qureshi; Allison K. Cabalka; Holly Bauser-Heaton; Alejandro J. Torres; Brian H. Morray; Aimee K. Armstrong; Oscar Millan-Iturbe; Lynn F. Peng; Jamil A. Aboulhosn; Witold Rużyłło; Felix Berger; Lars Sondergaard; Dietmar Schranz; John P. Cheatham; Thomas K. Jones; Peter Ewert; Stephan Schubert
• Keywords: Adult; Male; Reoperation; Pacemaker, Artificial; Adolescent; DURABILITY; pulmonary valve; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Humans; Registries; tetralogy of Fallot; Child; HOMOGRAFT; Heart Valve Prosthesis Implantation; BIOPROSTHETIC VALVES; OUTCOMES; Pulmonary Valve; VENTRICLE; Endocarditis; Ross procedure; Age Factors; Infant, Newborn; Infant; ADULTS; Middle Aged; Defibrillators, Implantable; 3. Good health; pulmonary atresia; pediatric; Child, Preschool; Heart Valve Prosthesis; TETRALOGY; OPERATION; Female; IMPLANTATION; FOLLOW-UP

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.This study sought to evaluate mid- and long-term outcomes after TPVR in a large multicenter cohort.International registry focused on time-related outcomes after TPVR.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).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.