Pediatrics & Therapeutics
Open Access
ISSN: 2161-0665
+44 1478 350008
ISSN: 2161-0665
+44 1478 350008
Constance G Weismann
Yale University, USA
Posters-Accepted Abstracts: Pediat Therapeut
Background: 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). The aim of this study was to compare patients who received trans-catheter Melody valves to those who underwent surgical PVR before, and at two time points following PVR. Methods: Retrospective review of echocardiograms was obtained at three time points: Last study before PVR, first study after PVR, most recent follow-up. We recorded patient characteristics and echocardiographic parameters of right ventricular (RV) and valve function. RVOTO was graded according to ASE guidelines for pulmonic stenosis (moderate: peak velocity 3-4 m/s). Statistical methods included Chi-square, linear regression and mixed linear model to control for co-factors. Results: We identified 76 patients who had undergone TC (N=42) or surgical (N=34) PVR between 2011 and 2014. Mean age was 21 (�?±14) years. There was no difference between the groups in age or body surface area. At baseline, more patients in group TC had at least moderate RVOTO with or without PI (32/42 vs. 3/34, p<0.001), and predominant PI was less common (10/42 vs. 29/34, p<0.001). At initial post-procedural echocardiogram there was no difference in valve function. 86% had at most mild RVOTO and 97% at most mild PI. At most recent follow-up, however, there was more valve dysfunction in the surgical group (moderate RVOTO 3/32 vs. 10/26, p=0.03; mild or moderate PI: 0/32 vs. 10/26, p=0.002). This remained significant after correcting for length of followup. 63 patients had quantitative assessment of RV function at a minimum of two time points. They were included in a mixed linear model that compared RV function between the groups, and controlled for predominance of RVOTO and/or PI prior to PVR. The TC group had an immediate increase in RV Sâ�?�?, but none of the other parameters changed significantly. Following surgical PVR there was an acute decrease of TAPSE, Sâ�?�? and Eâ�?�?, that only partially recovered at follow-up. Conclusion: Melody valve placement is associated with better pulmonary valve function in follow-up. Patients with surgical but not TC PVR had decreased RV function in follow-up, even when controlling for RVOTO and/or PI prior to PVR. Melody valve should therefore be the first choice for patients who are considered for PVR whenever possible.
Email: constance.weismann@yale.edu