title: Percutaneous pulmonary valve implantation: 5 years of follow-up: does age influence outcomes?
abstract: BACKGROUND
  Percutaneous pulmonary valve implantation (PPVI) is a safe, less invasive alternative to surgical valve replacement for the congenital heart disease patient with right ventricular (RV) outflow tract dysfunction. The aim of this study was to determine whether reverse RV remodeling after PPVI was persistent in the longer term and whether timing of PPVI influenced outcomes.
  
  
  RESULTS
  Consecutive patients from the pediatric and adult congenital heart disease programs were enrolled. Cardiac MRI, echocardiography, metabolic exercise testing, chest radiography, and hemodynamics before intervention were compared with repeated follow-up measurements to assess changes over time. Fifty-one patients (including 23 patients <16 years old) were followed for a mean 4.5±1.9 (0.9-6.9) years after implantation, 59% of patients having available comparative cardiac MRI data. Freedom from any reintervention was 87% and 68% at 3 and 5 years, and freedom from surgery was 90% at 5 years. For every decade younger at implantation, there was an increase of 3.9%±1.0% in cardiac MRI left ventricular ejection fraction (P<0.001) and 2.4±0.9 mL/kg/min in maxVO2 (P=0.005) and a decrease of 0.7±0.2 cm in RV end-diastolic dimension (P<0.001) after intervention. Younger patients displayed an additional decline in the RV/left ventricular end-diastolic volume ratio (P=0.05) and trended toward improved RV ejection fraction in late follow-up (50%±7% versus 41%±12%, P=0.07).
  
  
  CONCLUSIONS
  This is the largest series to show that PPVI at a younger age yields incremental improvements in RV size and maximum oxygen consumption. Early valve implantation is associated with better RV function and should be considered in management planning for this population.
authors: From the Department of Pediatrics, Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children and Division of Cardiology (S.B., K.-J.L., R.C., M.K.F., B.W.M., C.M., L.B.), and University Health Network Toronto General Division (A.C., E.H., M.O.), University of Toronto School of Medicine, Toronto, Canada.
authors: Sharon
authors: S
authors: Borik
authors: From the Department of Pediatrics, Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children and Division of Cardiology (S.B., K.-J.L., R.C., M.K.F., B.W.M., C.M., L.B.), and University Health Network Toronto General Division (A.C., E.H., M.O.), University of Toronto School of Medicine, Toronto, Canada.
authors: Andrew
authors: A
authors: Crean
authors: From the Department of Pediatrics, Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children and Division of Cardiology (S.B., K.-J.L., R.C., M.K.F., B.W.M., C.M., L.B.), and University Health Network Toronto General Division (A.C., E.H., M.O.), University of Toronto School of Medicine, Toronto, Canada.
authors: Eric
authors: E
authors: Horlick
authors: From the Department of Pediatrics, Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children and Division of Cardiology (S.B., K.-J.L., R.C., M.K.F., B.W.M., C.M., L.B.), and University Health Network Toronto General Division (A.C., E.H., M.O.), University of Toronto School of Medicine, Toronto, Canada.
authors: Mark
authors: M
authors: Osten
authors: From the Department of Pediatrics, Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children and Division of Cardiology (S.B., K.-J.L., R.C., M.K.F., B.W.M., C.M., L.B.), and University Health Network Toronto General Division (A.C., E.H., M.O.), University of Toronto School of Medicine, Toronto, Canada.
authors: Kyong-Jin
authors: KJ
authors: Lee
authors: From the Department of Pediatrics, Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children and Division of Cardiology (S.B., K.-J.L., R.C., M.K.F., B.W.M., C.M., L.B.), and University Health Network Toronto General Division (A.C., E.H., M.O.), University of Toronto School of Medicine, Toronto, Canada.
authors: Rajiv
authors: R
authors: Chaturvedi
authors: From the Department of Pediatrics, Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children and Division of Cardiology (S.B., K.-J.L., R.C., M.K.F., B.W.M., C.M., L.B.), and University Health Network Toronto General Division (A.C., E.H., M.O.), University of Toronto School of Medicine, Toronto, Canada.
authors: Mark K
authors: MK
authors: Friedberg
authors: From the Department of Pediatrics, Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children and Division of Cardiology (S.B., K.-J.L., R.C., M.K.F., B.W.M., C.M., L.B.), and University Health Network Toronto General Division (A.C., E.H., M.O.), University of Toronto School of Medicine, Toronto, Canada.
authors: Brian W
authors: BW
authors: McCrindle
authors: From the Department of Pediatrics, Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children and Division of Cardiology (S.B., K.-J.L., R.C., M.K.F., B.W.M., C.M., L.B.), and University Health Network Toronto General Division (A.C., E.H., M.O.), University of Toronto School of Medicine, Toronto, Canada.
authors: Cedric
authors: C
authors: Manlhiot
authors: From the Department of Pediatrics, Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children and Division of Cardiology (S.B., K.-J.L., R.C., M.K.F., B.W.M., C.M., L.B.), and University Health Network Toronto General Division (A.C., E.H., M.O.), University of Toronto School of Medicine, Toronto, Canada. lee.benson@sickkids.ca.
authors: Lee
authors: L
authors: Benson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D017079:Exercise Tolerance; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009864:Ontario; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020257:Ventricular Remodeling; D055815:Young Adult
keywords: catheterization; congenital; heart defects; tetralogy of Fallot