title: Early outcomes in patients undergoing transcatheter versus surgical pulmonary valve replacement.
abstract: To identify predictors of morbidity and mortality in patients undergoing either transcatheter pulmonary valve replacement (TPVR) or surgical pulmonary valve replacement (SPVR) in an effort to quantify any early benefit of TPVR over SPVR.
  
  
  
  Using a risk-adjusted propensity score model, we compare early major morbidity and mortality between patients undergoing SPVR and TPVR at our institution between January 2006 and January 2014.
  
  
  
  145 patients in the SPVR cohort and 78 patients in the TPVR cohort were included. Primary pulmonary regurgitation was more common in the SPVR group (76.6% vs 23.1%, p<0.001) and primary pulmonary stenosis was more common in the TPVR group (9.7% vs 44.9%, p< 0.001). In unadjusted analysis, major morbidity and mortality occurred in 11.7% of SPVR patients versus 3.8% of TPVR patients (p=0.04). However, following risk adjustment and inclusion of a propensity score, no significant difference was seen between the two modalities. A larger right ventricular end-diastolic dimension (RVEDVI) was the only preoperative variable associated with the primary end point (OR 1.013/10 mL/m2increase, p=0.03). Hospital length of stay was significantly longer in patients undergoing SPVR (6.9±1.0 days SPVR vs 1.2±0.3 days TPVR, p<0.0001), with similar hospital costs between groups (mean: US$44 660±5071 SPVR vs US$48 355±1000 TPVR, p=0.7).
  
  
  
  Following risk adjustment, no significant differences were observed between SPVR and TPVR strategies. TPVR was associated with a shorter hospitalisation; however, total hospitalisation costs were similar between groups.
authors.affiliation: Department of Medicine, University of Washington, Washington, Seattle, USA.
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: Steinberg
authors.affiliation: Department of Pediatrics, Seattle Children's Hospital, Washington, Seattle, USA.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Jones
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington School of Medicine, Washington, Seattle, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Verrier
authors.affiliation: Department of Medicine, University of Washington, Washington, Seattle, USA.|Department of Pediatrics, Seattle Children's Hospital, Washington, Seattle, USA.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Stout
authors.affiliation: Department of Cardiac Clinic & Services, University of Washington Medical Center, Washington, Seattle, USA.
authors.forename: Eric V
authors.initials: EV
authors.lastname: Krieger
authors.affiliation: Department of Surgery, Phoenix Children's Hospital, Arizona, Phoenix, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Karamlou
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Surgical pulmonary valve replacement; Transcatheter pulmonary valve replacement