Key result
Surgical treatment decreased transvalvular mean pressure gradient from 63.28 to 16.46 mmHg, with post-1995 valve sparing techniques yielding significantly greater freedom from reintervention.
Why the study?
Surgical treatment of isolated pulmonary valve stenosis has evolved from focusing solely on lowering right ventricle pressure to also preserving pulmonary valve function, but the impact on long-term results was unclear.
Do pulmonary valve sparing surgical techniques improve long-term outcomes in infants and children with isolated pulmonary valve stenosis compared to older surgical techniques?
Cohort (n=123)
No
Do pulmonary valve sparing surgical techniques improve long-term outcomes in infants and children with isolated pulmonary valve stenosis compared to older surgical techniques?
Current pulmonary valve sparing techniques in pediatric patients with isolated pulmonary valve stenosis are associated with better freedom from reintervention and preserved valve function compared to older surgical methods.
Background: Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. In our study, we sought to analyze the effect of such evolving philosophy on long-term results. Methods: All consecutive patients treated in our center between July 1983 and March 2019 were included. Patients were categorized into 2 groups based on the introduction into treatment practice of sparing valve techniques (1995). Actuarial survival, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease, and pulmonary valve function at follow-up were analyzed. Results: One hundred twenty-three patients operated before (Group I, n=81) or since (Group II, n=42) 1995 were enrolled in the study. Mean age and weight were 3.0 ± 0.36 years and 16.6 ± 1.7kg, respectively. Early mortality occurred exclusively in 3 patients of Group 1. Transvalvular mean pressure gradient decreased in the entire patient population (from 63.28 ± 12.9mmHg to 16.46 ± 7.9mmHg). At a mean follow-up interval of 4.9 ± 33 years, freedom from death was comparable, but freedom from right ventricular outflow tract reintervention was significantly greater in Group II. Although the transvalvular gradient remained stable over time in non-reoperated survivors (mean value of 16.46 ± 7.9mmHg), pulmonary valve function on 2D-Echo showed severe incompetence in 2 patients of Group I and just mild to moderate incompetence in 20 patients of Group II, with a significantly negative effect of unsuccessful preoperative pulmonary balloon valvuloplasty (14/20 vs 6/20, p=0.025) in the latter. Conclusion: Current pulmonary valve sparing techniques are associated with better results, particularly in terms of freedom from re-interventions and pulmonary valve function at follow-up. Balloon valvuloplasty prior to surgery may worsen operative results, promoting pulmonary insufficiency and therefore should probably be avoided in all patients in whom anatomical characteristics predict failure of percutaneous therapy.
No takes yet. Share an insight, caveat, or question.
Sonia B. Albanese Albanese (2021) conducted a cohort in Isolated pulmonary valve stenosis (n=123). Pulmonary valve sparing techniques vs. Surgical treatment before 1995 was evaluated on Actuarial survival, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease, and pulmonary valve function. Surgical treatment decreased transvalvular mean pressure gradient from 63.28 to 16.46 mmHg, with post-1995 valve sparing techniques yielding significantly greater freedom from reintervention.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: