title: Risk Factors for Prosthetic Pulmonary Valve Failure in Patients With Congenital Heart Disease.
abstract: The incidence and risk factors for prosthetic pulmonary valve failure (PPVF) should be considered when determining optimal timing for pulmonary valve replacement (PVR) in asymptomatic patients with congenital heart disease (CHD). The cumulative freedom for reintervention due to PPVF after 146 PVR in 114 patients with CHD was analyzed. Six potential risk factors (underlying cardiac defect, history of palliative procedures, number of previous cardiac interventions, hemodynamic indication for PVR, type of intervention, and age at intervention) were analyzed using Cox proportional hazard modeling. Receiver operating characteristic (ROC) curves were used for discrimination. Internal validation in patients with tetralogy of Fallot was also performed. Median age at intervention was 23 years. There were 60 reinterventions due to PPVF (41%). Median event-free survival was 14 years (95% confidence interval [CI] 12 to 16 years). The only independent risk factor was the age at intervention (hazard ratio [HR] 0.93, 95% CI 0.90 to 0.97; p = 0.001; area under the ROC curve 0.95, 95% CI 0.92 to 0.98; p <0.001). The best cut-off point was 20.5 years. Freedom from reintervention for PPVF 15 years after surgery was 70% when it was performed at age >20.5 years compared with 33% when age at intervention was <20.5 years (p = 0.004). Internal validation in 102 PVR in patient cohort with tetralogy of Fallot (ROC area 0.98, 95% CI 0.96 to 1.0; p <0.001) was excellent. In conclusion, age at intervention is the main risk factor of reintervention for PPVF. The risk of reintervention is 2-fold when PVR is performed before the age of 20.5 years.
authors: Unidad de Cardiopatías Congénitas del Adulto, La Paz University Hospital, Madrid, Spain; Instituto de Investigacion Sanitaria, Gregorio Marañon University Hospital, Madrid, Spain. Electronic address: joliver@salud.madrid.org.
authors: Jose Maria
authors: JM
authors: Oliver
authors: Unidad de Cardiopatías Congénitas del Adulto, La Paz University Hospital, Madrid, Spain; Servicio de Cardiología, La Paz University Hospital, Madrid, Spain.
authors: Diego
authors: D
authors: Garcia-Hamilton
authors: Unidad de Cardiopatías Congénitas del Adulto, La Paz University Hospital, Madrid, Spain; Servicio de Cardiología, La Paz University Hospital, Madrid, Spain.
authors: Ana Elvira
authors: AE
authors: Gonzalez
authors: Unidad de Cardiopatías Congénitas del Adulto, La Paz University Hospital, Madrid, Spain; Servicio de Cardiología, La Paz University Hospital, Madrid, Spain.
authors: Jose
authors: J
authors: Ruiz-Cantador
authors: Unidad de Cardiopatías Congénitas del Adulto, La Paz University Hospital, Madrid, Spain; Servicio de Cardiología, La Paz University Hospital, Madrid, Spain.
authors: Angel
authors: A
authors: Sanchez-Recalde
authors: Unidad de Cardiopatías Congénitas del Adulto, La Paz University Hospital, Madrid, Spain; Servicio de Cirugía Cardiovascular Pediátrica y cardiopatías Congénitas, La Paz University Hospital, Madrid, Spain.
authors: Maria Luz
authors: ML
authors: Polo
authors: Unidad de Cardiopatías Congénitas del Adulto, La Paz University Hospital, Madrid, Spain; Servicio de Cirugía Cardiovascular Pediátrica y cardiopatías Congénitas, La Paz University Hospital, Madrid, Spain.
authors: Angel
authors: A
authors: Aroca
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D015994:Incidence; D008297:Male; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D011665:Pulmonary Valve Insufficiency / Q000150:complications / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000601:surgery*; D012372:ROC Curve; D012086:Reoperation; D012307:Risk Factors; D055815:Young Adult