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Repeat Transcatheter vs. Surgical Pulmonary Valve Replacement
Study Questions:
What are the differences in outcomes between patients undergoing transcatheter pulmonary valve-in-valve replacement (TPVR) as compared with repeat surgical pulmonary valve replacement (SPVR)?
Methods:
A retrospective review was performed at a single center. Patients with bioprosthetic valve undergoing re-intervention were identified, with documentation of clinical and echocardiographic follow-up at 30 days, 1 year, and 3 years.
Results:
Baseline differences between the two groups included a larger proportion of men and greater number of patients with baseline New York Heart Association functional class III or IV. There was no difference in mortality, cardiovascular readmission, or need for repeat pulmonary valve intervention. There was less right ventricular dysfunction at 30 days (2.9% vs. 46.7%; p < 0.01) in the TPVR group, and while this effect persisted at 1- and 3-year follow-up, it did not remain significant.
Conclusions:
TPVR is a good alternative to SPVR for patients with bioprosthetic pulmonary valves requiring re-intervention.
Perspective:
This study investigated outcomes with transcatheter as opposed to surgical valve replacement for patients with previous bioprosthetic pulmonary valve replacement. The study showed comparable intermediate-term results, with the beneficial effect of less right ventricular dysfunction at the 30-day follow-up examination. The primary limitation of this study is its retrospective design and the possibility of selection bias, as the choice of intervention was left to the practitioner’s discretion. The study confirms an important role for transcatheter therapies in patients requiring re-intervention on bioprosthetic pulmonary valves.
Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound
Keywords: Bioprosthesis, Cardiac Surgical Procedures, Echocardiography, Heart Defects, Congenital, Heart Valve Diseases, Heart Valve Prosthesis, Patient Readmission, Pulmonary Valve, Transcatheter Aortic Valve Replacement, Ventricular Dysfunction, Right
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