title: Comparison of Patients Undergoing Surgical Versus Transcatheter Pulmonary Valve Replacement: Criteria for Referral and Mid-Term Outcome.
abstract: Pulmonary regurgitation and/or stenosis (PS) is challenging in patients with congenital heart defects. Our aim was to identify if criteria for referral were different between surgical (SPVR) and transcatheter pulmonary valve replacement (TPVR) populations, and to further assess if any baseline differences influence the resultant ventricular remodeling at medium-term follow-up. Retrospective chart review of patients post-SPVR or TPVR at our center from 2013 to 2015 was conducted. Volumetric data from cardiac magnetic resonance (CMR), 1 year before and 1 year after PVR was obtained. PS was defined as peak-peak gradient ≥35 mmHg by catheterization or peak gradient ≥50 mmHg by echocardiography. Thirty patients underwent PVR: 15 SPVR and 15 TPVR (1 hybrid). The indications for SPVR referral were: 2+ CMR parameters in 80% of patients; decreased left ventricular ejection fraction and hemodynamic findings and/or abnormal exercise stress test in 20%. The indications for TPVR referral were predominantly symptoms ± hemodynamic findings in 66% of patients, 2+ CMR findings in 44% of patients. At referral, SPVR group had significantly larger right ventricular (RV) volumes than TPVR group. Biventricular function was not significantly different. Post-PVR, both groups had significantly decreased RV volumes and increased LV diastolic volumes. The SPVR group improved LV cardiac output and biventricular function whereas TPVR group had no significant improvement. The patients in the SPVR group were mostly referred based on CMR volumetric criteria, whereas the patients in the TPVR group were mostly referred due to exercise intolerance with only occasional abnormalities on CMR. 1 year after PVR, both groups had near-normal biventricular volumes and function irrespective of characteristics at referral.
authors.affiliation: Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA. jennyzablah@gmail.com.|Children's Hospital of Colorado, 13123 East 16th Avenue, Box 100, Aurora, CO, 80045, USA. jennyzablah@gmail.com.
authors.forename: Jenny E
authors.initials: JE
authors.lastname: Zablah
authors.affiliation: Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA.
authors.forename: Nilanjana
authors.initials: N
authors.lastname: Misra
authors.affiliation: Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA.
authors.forename: Dorota
authors.initials: D
authors.lastname: Gruber
authors.affiliation: Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA.
authors.forename: Dipak
authors.initials: D
authors.lastname: Kholwadwala
authors.affiliation: Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA.
authors.forename: Shilpi
authors.initials: S
authors.lastname: Epstein
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D016276:Ventricular Function; D055815:Young Adult
keywords: Melody valve; Pulmonary valve replacement; Right ventricular remodeling