Key result
Patients undergoing transcatheter pulmonary valve replacement had a significantly smaller mean end-systolic right ventricular outflow tract perimeter (88.9 mm) compared to those requiring surgical or hybrid approaches (106.6 mm).
Why the study?
Pre-procedure cardiac MRI workup includes measuring the right ventricular outflow tract perimeter at the landing zone in end-systole, but whether these values correspond to the palliative pulmonary valve replacement approach performed required investigation.
Does pre-procedural right ventricular outflow tract perimeter measurement correlate with the type of pulmonary valve replacement performed (transcatheter vs surgical/hybrid)?
Cohort (n=37)
Blinded to clinical data during MRI post-processing
No
Does pre-procedural right ventricular outflow tract perimeter measurement correlate with the type of pulmonary valve replacement performed (transcatheter vs surgical/hybrid)?
Absolute Event Rate: 88.9% vs 106.6%
p-value: p=0.02
Right ventricular outflow tract perimeter measurement to determine circularised diameter is a useful imaging standard for planning pulmonary valve replacement and determining candidacy for transcatheter versus surgical/hybrid approaches.
Smaller end-systolic RVOT perimeter was associated with transcatheter approach; leaves open whether perimeter thresholds can guide selection in prospective studies.
BACKGROUND: Right ventricular outflow tract intervention spans transcatheter, surgical, or hybrid pulmonary valve replacement methodologies. Standardised pre-procedure workup includes cardiac MRI to identify an intended valve site (landing zone). Our institutional practice includes measurement of the right ventricular outflow tract perimeter (circumference) of this site in end-systole. Our primary aim was to compare patients by their perimeter values to the palliative interventions performed (transcatheter versus surgical/hybrid methodologies). METHODS: Retrospective review of patients undergoing pulmonary valve replacement from January 2017 to 2021. We performed perimeter measurements at the intended valve site on advanced imaging; the outcomes of interventions were outlined via descriptive and statistical analyses. RESULTS: A total of 37 patients underwent pulmonary valve replacement that met study criteria - 21 transcatheter, 7 surgical, and 9 hybrid. Median age at intervention was 26 years (range 8-70). The mean end-systolic perimeter of the transcatheter cohort was 88.9 ± 8.7 mm and in the surgical/hybrid cohort measured 106.6 ± 7.5 mm. For the transcatheter cohort, the median "circularised" diameter derived from the perimeter measurement (divided by π) was 27.7 mm (range 24.3-32.4). Notably, this correlated (r = 0.93, p < 0.01) with the median diameter of the narrowest region during actual transcatheter right ventricular outflow tract balloon sizing (lateral imaging) of 27.1 mm (range 23.2-30.1). CONCLUSIONS: Right ventricular outflow tract perimeter measurement to determine circularised diameter is useful in planning pulmonary valve replacement in terms of candidacy of transcatheter versus the need for a surgical/hybrid approach. The circularised diameter correlates with transcatheter right ventricular outflow tract balloon sizing.
No takes yet. Share an insight, caveat, or question.
Ligon et al. (2022) conducted a cohort in Pulmonary regurgitation requiring pulmonary valve replacement (n=37). Transcatheter pulmonary valve replacement vs. Surgical/hybrid pulmonary valve replacement was evaluated on Mean end-systolic right ventricular outflow tract perimeter (p=0.02). Patients undergoing transcatheter pulmonary valve replacement had a significantly smaller mean end-systolic right ventricular outflow tract perimeter (88.9 mm) compared to those requiring surgical or hybrid approaches (106.6 mm).
Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context: