Transcatheter valve replacement in adults with congenital heart disease had a 10-year valve reintervention incidence of 35%, similar between Sapien and Melody prostheses (41% vs 33%; P=0.11).
Cohort (n=341)
No
What are the long-term outcomes and prosthesis longevity after transcatheter valve replacement in adults with congenital heart disease?
Transcatheter valve replacement in adults with congenital heart disease provides clinical improvement, but is limited by significant increases in prosthetic valve gradients and a 35% reintervention rate at 10 years.
Absolute Event Rate: 41% vs 33%
p-value: p=0.11
BACKGROUND: The current study aims to describe outcomes after transcatheter valve replacement in adults with congenital heart disease. METHODS: Retrospective study of adults with congenital heart disease who underwent transcatheter valve replacement and had a 1-year follow-up postintervention at Mayo Clinic (2010–2024). The study period was divided into early (2010–2014), mid (2015–2019), and late (2020–2024) eras. The primary outcome was valve reintervention. The secondary outcomes were all-cause mortality and temporal change in prosthetic valve gradient and clinical indices of disease severity. RESULTS: Overall, 341 patients (age 38±17 years; 175 51% men) received 346 prostheses (pulmonary N=236, 68%, tricuspid N=75, 22%, aortic N=22, 8%, and mitral N=7, 2%). The prostheses were Sapien (N=181, 52%), Melody (N=142, 41%), and Harmony prostheses (N=23, 7%). The number of transcatheter valve implantations increased from the early era (N=75), mid era (N=109), to the late era (N=162). The 10-year incidence of valve reintervention was 35%, and was similar between Sapien versus Melody prosthesis (41% versus 33%; P =0.11). The 10-year incidence of all-cause mortality was 13%. There was a temporal increase in prosthetic valve Doppler mean gradient (baseline versus 10 years) for pulmonary (12±5 versus 28±11 mmHg; P <0.001), tricuspid (3±1 versus 8±3 mmHg; P <0.001), and aortic prosthesis (13±5 versus 26±12 mmHg; P <0.001). There was a temporal increase in predicted peak oxygen consumption (absolute ∆, 9% 95% CI, 4–13; P =0.006) and a decrease in NT-proBNP (N-terminal pro-B-type natriuretic peptide) level (absolute ∆, −138 pg/mL 95% CI, −209 to −64; P <0.001) at 1-year postintervention. CONCLUSIONS: There has been a temporal increase in the number of transcatheter valve implantations over time. Transcatheter valve replacement was associated with clinical improvement across multiple domains. However, there was a significant increase in prosthetic valve gradient within 10 years of follow-up, suggesting limited prosthesis longevity. There is a need for strategies to improve prosthetic valve longevity, which in turn may improve outcomes in this population.
Egbe et al. (Mon,) conducted a cohort in congenital heart disease (n=341). Transcatheter valve replacement (Sapien prosthesis) vs. Melody prosthesis was evaluated on valve reintervention (p=0.11). Transcatheter valve replacement in adults with congenital heart disease had a 10-year valve reintervention incidence of 35%, similar between Sapien and Melody prostheses (41% vs 33%; P=0.11).