Key result
Transcatheter pulmonary valve replacement resulted in zero deaths compared to 5.6% mortality in the surgical pulmonary valve replacement group, alongside fewer major complications and shorter hospital stays.
Why the study?
Transcatheter pulmonary valve replacement has emerged as an alternative to surgical replacement after tetralogy of Fallot repair, prompting a comparison of outcomes between the two approaches.
Does transcatheter pulmonary valve replacement improve clinical outcomes compared to surgical pulmonary valve replacement in patients after tetralogy of Fallot repair?
Cohort (n=215)
No
Does transcatheter pulmonary valve replacement improve clinical outcomes compared to surgical pulmonary valve replacement in patients after tetralogy of Fallot repair?
Absolute Event Rate: 0% vs 5.6%
p-value: p=0.041
TPVR is associated with lower mortality, fewer major complications, and shorter hospital stays compared to SPVR in patients after tetralogy of Fallot repair, though SPVR remains preferable for those with native RVOT >30 mm.
TPVR was associated with lower mortality and complications post-TOF repair; hypothesis-generating and requires randomized confirmation before practice change.
Background Transcatheter pulmonary valve replacement (TPVR) has become an alternative to surgical pulmonary valve placement (SPVR) for patients after tetralogy of Fallot repair. This study compared the outcomes of TPVR with those of SPVR. Methods We reviewed data from patients who underwent pulmonary valve replacement with a median of 2 years of follow-up. Results Between 2010 and 2021, 215 patients underwent pulmonary valve replacement (72 TPVR and 143 SPVR). The median size of the right ventricular end-diastolic volume index in the TPVR group was 165 mL/m 2 (IQR, 136-190) and 184 mL/m 2 (IQR, 163-230) in the SPVR group ( P = .001). The median value of the maximum landing zone at the right ventricular outflow tract (RVOT) in patients with native RVOT was 26 mm (IQR, 24-28) in the 43 patients in the TPVR group and 31 mm (IQR, 28-34) in the 101 patients in the SPVR group ( P < .001). The median size of the pulmonary valve implant for the native RVOT in the TPVR group was 29.0 mm (IQR, 26.0-29.0) and 24.0 mm (IQR, 24.0-24.0) in the SPVR group ( P < .001). There were no deaths in the TPVR group and 8 deaths in the SPVR group ( P = .041). Major complications and the length of hospitalization were lower in the TPVR group ( P = .001). After 2 years, the mean decrease in QRS duration was 5 milliseconds (IQR, 1-14) in the TPVR group and 1 millisecond (IQR, −4 to 10) in the SPVR group ( P = .006). Conclusions TPVR allows for larger implants, resulting in lower mortality, shorter hospital stays, and fewer major cardiac events. SPVR may be preferable in patients with larger (>30 mm) native RVOT and in those who require concomitant surgical procedures.
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Durongpisitkul et al. (2022) conducted a cohort in Tetralogy of Fallot or pulmonary atresia with ventricular septal defect requiring pulmonary valve replacement (n=215). Transcatheter pulmonary valve replacement (TPVR) vs. Surgical pulmonary valve replacement (SPVR) was evaluated on Mortality (p=0.041). Transcatheter pulmonary valve replacement resulted in zero deaths compared to 5.6% mortality in the surgical pulmonary valve replacement group, alongside fewer major complications and shorter hospital stays.
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