Key result
Implantable haemodynamic monitoring in adults with subaortic right ventricles did not significantly change heart failure hospitalizations compared to the year prior (median 0 vs 0 per year, p=0.984).
Why the study?
Pulmonary hypertension is common in patients with subaortic right ventricles, but echocardiography is a poor screening tool and data on implantable invasive haemodynamic monitoring in this population are limited.
Does implantable invasive haemodynamic monitoring reduce heart failure hospitalisations in adults with subaortic right ventricles?
Observational (n=18)
No
Does implantable invasive haemodynamic monitoring reduce heart failure hospitalisations in adults with subaortic right ventricles?
Absolute Event Rate: 0% vs 0%
p-value: p=0.984
Implantable haemodynamic monitoring is feasible in adults with subaortic right ventricles for medical titration and monitoring, though it did not significantly reduce heart failure hospitalisations in this small cohort.
No HFH reduction with IHM; leaves open its role in subaortic right ventricles pending larger studies.
BACKGROUND: Pulmonary hypertension (PH) is a common complication in patients with complete dextro-transposition of the great arteries (TGA) after atrial switch (D-TGA/AS) and congenitally corrected TGA (ccTGA). In this population with subaortic right ventricles (sRVs), echocardiography is a poor screening tool for PH; implantable invasive haemodynamic monitoring (IHM) could be used for this purpose, but data are limited. The aim of this study is to report on novel uses of IHM in patients with sRV. METHODS: This retrospective study describes the uses of IHM, impact of IHM on heart failure hospitalisation (HFH) and device-related complications in adults with sRV from a single centre (2015-2022). RESULTS: IHM was placed in 18 patients with sRV (median age 43 (range 30-54) years, 8 female, 16 with D-TGA/AS, 2 with ccTGA); 16 had moderate or severe sRV systolic dysfunction, 13 had PH on catheterisation. IHM was used for (1) Medical therapy titration, (2) Medical management after ventricular assist device in patients with transplant-limiting PH and (3) Serial monitoring of pulmonary artery pressures without repeat catheterisations to help identify the optimal time for heart transplant referral. In follow-up (median 23 months), HFHs/year were similar to the year prior to IHM (median 0 (IQR 0-1.0) before vs 0 (0-0.8) after, p=0.984). Device migration occurred in one, without long-term sequelae. CONCLUSIONS: Uses of IHM in patients with sRV are described which may minimise the need for serial catheterisations in a population where PH is prevalent. HFHs were low overall but not impacted by IHM. One device-related complication occurred without long-term consequence.
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Marshall et al. (2023) conducted an observational in Subaortic right ventricles (n=18). Implantable invasive haemodynamic monitoring vs. Year prior to monitoring was evaluated on Heart failure hospitalisation (HFH) per year (p=0.984). Implantable haemodynamic monitoring in adults with subaortic right ventricles did not significantly change heart failure hospitalizations compared to the year prior (median 0 vs 0 per year, p=0.984).
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