Pulmonary Valve Replacement in Tetralogy of Fallot: Procedural Volume and Durability of Bioprosthetic Pulmonary Valves.
JACC Cardiovasc Interv
; 17(2): 217-227, 2024 Jan 22.
Article
em En
| MEDLINE
| ID: mdl-38127022
ABSTRACT
BACKGROUND:
Robust data on changes in pulmonary valve replacement (PVR) procedural volume and predictors of bioprosthetic pulmonary valve (BPV) durability in patients with tetralogy of Fallot (TOF) are scarce.OBJECTIVES:
This study sought to assess temporal trends in PVR procedural volume and BPV durability in a nationwide, retrospective TOF cohort.METHODS:
Data were obtained from patient records. Robust linear regression was used to assess temporal trends in PVR procedural volume. Piecewise exponential additive mixed models were used to estimate BPV durability, defined as the time from implantation to redo PVR with death as a competing risk, and to assess risk factors for reduced durability.RESULTS:
In total, 546 PVR were performed in 384 patients from 1976 to 2021. The annual number of PVR increased from 0.4 to 6.0 per million population (P < 0.001). In the last decade, the transcatheter PVR volume increased by 20% annually (P < 0.001), whereas the surgical PVR volume did not change significantly. The median BPV durability was 17 years (Q1 10-Q3 10 years-not applicable). There was no significant difference in the durability of different BPV after adjustment for confounders. Age at PVR (HR 0.78 per 10 years from <1 year; 95% CI 0.63-0.96; P = 0.02) and true inner valve diameter (9-17 mm vs 18-22 mm HR 0.40; 95% CI 0.22-0.73; P = 0.003 and 18-22 mm vs 23-30 mm HR 0.59; 95% CI 0.25-1.39; P = 0.23) were associated with reduced BPV durability in multivariate models.CONCLUSIONS:
The PVR procedural volume has increased over time, with a greater increment in transcatheter than surgical PVR during the last decade. Younger patient age at PVR and a smaller true inner valve diameter predicted reduced BPV durability.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Valva Pulmonar
/
Insuficiência da Valva Pulmonar
/
Tetralogia de Fallot
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Implante de Prótese de Valva Cardíaca
Limite:
Child
/
Humans
Idioma:
En
Revista:
JACC Cardiovasc Interv
Assunto da revista:
ANGIOLOGIA
/
CARDIOLOGIA
Ano de publicação:
2024
Tipo de documento:
Article