Log in to MyACC
Pulmonary Valve Replacement in Tetralogy of Fallot
Quick Takes
- Pulmonary valve replacement (PVR) procedural volume has increased over the last 45 years, with increasing use of transcatheter valves over the last decade.
- Younger age at PVR and smaller inner valve diameters were associated with reduced bioprosthetic valve durability.
Study Questions:
What are the temporal trends in pulmonary valve replacement (PVR) procedural volume and durability of bioprosthetic pulmonary valves (BPV)?
Methods:
A nationwide retrospective cohort study was performed using the Danish National Patient Registry and the EVITRA (Early Versus Later Re-valving in Tetralogy of Fallot With Free Pulmonary Regurgitation) study. Temporal trends in PVR procedural volume as well as BPV durability were assessed.
Results:
A total of 546 PVRs were performed in 384 patients between 1976 and 2021. Overall median age at PVR was 18 years. The annual number of PVRs increased from 0.4 to 6.0 per million population. In the last decade, transcatheter PVR volume increased by 20% annually, while the surgical PVR volume was stable. Median BPV durability was 17 years. There was no significant difference in durability of various types of BPV after adjustment for confounders. Younger age at PVR (hazard ratio [HR], 0.78 per 10 years from <1 year; 95% confidence interval [CI], 0.63-0.96; p = 0.02) and smaller true inner diameter (9-17 mm vs. 18-22 mm: HR, 0.40; 95% CI, 0.22-0.73; p = 0.003 and 18-22 mm vs. 23-30 mm: HR, 0.59; 95% CI, 0.25-1.39; p = 0.23) were associated with reduced BPV durability in multivariate models.
Conclusions:
The authors conclude that the PVR procedural volume has increased over time, with a greater increment in transcatheter than surgical PVR during the last decade. Younger patient age and smaller true inner valve diameter were associated with reduced BPV durability in multivariate models.
Perspective:
PVR is the most common re-operation performed in adults with congenital heart disease. The study provides helpful information for prognosticating valve durability (median durability of 17 years) in patients with tetralogy of Fallot after PVR. There was no clear difference between different types of valves, although the study may not have been powered to detect such a difference. There have been mixed data regarding “oversizing” valves, which may be of particular interest in the current era of potentially preparing patients for multiple transcatheter valve-in-valve procedures. This study did not show a clear improvement in durability for valves with >22 mm internal diameter. Valve durability will need to be continually monitored given the changing profile of PVR with increasing numbers of transcatheter procedures.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Congenital Heart Disease, Valvular Heart Disease
Keywords: Heart Defects, Congenital, Tetralogy of Fallot
< Back to Listings
