A propensity score-adjusted analysis of clinical outcomes after pulmonary valve replacement in tetralogy of Fallot.
Heart
; 104(9): 738-744, 2018 05.
Article
in En
| MEDLINE
| ID: mdl-29092913
ABSTRACT
OBJECTIVE:
To determine the association of pulmonary valve replacement (PVR) with death and sustained ventricular tachycardia (VT) in patients with repaired tetralogy of Fallot (rTOF).METHODS:
Subjects with rTOF and cardiac magnetic resonance from an international registry were included. A PVR propensity score was created to adjust for baseline differences. PVR consensus criteria were predefined as pulmonary regurgitation >25% and ≥2 of the following criteria right ventricular (RV) end-diastolic volume >160 mL/m2, RV end-systolic volume >80 mL/m2, RV ejection fraction (EF) <47%, left ventricular EF <55% and QRS duration >160 ms. The primary outcome included (aborted) death and sustained VT. The secondary outcome included heart failure, non-sustained VT and sustained supraventricular tachycardia.RESULTS:
In 977 rTOF subjects (age 26±15 years, 45% PVR, follow-up 5.3±3.1 years), the primary and secondary outcomes occurred in 41 and 88 subjects, respectively. The HR for subjects with versus without PVR (time-varying covariate) was 0.65 (95% CI 0.31 to 1.36; P=0.25) for the primary outcome and 1.43 (95% CI 0.83 to 2.46; P=0.19) for the secondary outcome after adjusting for propensity and other factors. In subjects (n=426) not meeting consensus criteria, the HR for subjects with (n=132) versus without (n=294) PVR was 2.53 (95% CI 0.79 to 8.06; P=0.12) for the primary outcome and 2.31 (95% CI 1.07 to 4.97; P=0.03) for the secondary outcome.CONCLUSION:
In this large multicentre rTOF cohort, PVR was not associated with a reduced rate of death and sustained VT at an average follow-up of 5.3 years. Additionally, there were more events after PVR compared with no PVR in subjects not meeting consensus criteria.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pulmonary Valve
/
Pulmonary Valve Insufficiency
/
Tetralogy of Fallot
/
Tachycardia, Ventricular
/
Heart Valve Prosthesis Implantation
Type of study:
Clinical_trials
/
Observational_studies
Limits:
Adult
/
Female
/
Humans
/
Male
Language:
En
Journal:
Heart
Journal subject:
CARDIOLOGIA
Year:
2018
Type:
Article
Affiliation country:
Netherlands