Ventricular arrhythmia burden after transcatheter versus surgical pulmonary valve replacement

Wadia, Subeer; Lluri, Gentian; Aboulhosn, Jamil; Shivkumar, Kalyanam; Reemtsen, Brian; Laks, Hillel; Biniwale, Reshma; Levi, Daniel S.; Salem, Morris; Moore, Jeremy P.

doi:10.1136/heartjnl-2017-312769

Cited by 8 publications

(16 citation statements)

References 26 publications

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“…There appears to be no significant increase in ventricular ectopy long term [ 18 ]. Moreover, when comparing PPVI to sPVR cohorts, the ventricular ectopy burden seems comparable in the medium and long term [ 23 ]. Regarding our patients with more severe VA, 2/3 had documented monomorphic VTs that were probably re-entrant, as well described in TOF [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Ventricular Arrhythmias and Sudden Death Following Percutaneous Pulmonary Valve Implantation in Pediatric Patients

et al. 2022

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Reports have suggested a transient increase in ventricular ectopy early after percutaneous pulmonary valve implantation (PPVI). Little is known about the potential for more serious ventricular arrhythmias (VA) in children who undergo PPVI. We sought to evaluate the incidence of severe VA following PPVI in a pediatric population and to explore potential predictive factors. A retrospective cohort study was conducted of patients who underwent PPVI under 20 years of age in our institution from January 2007 to December 2019. The primary outcome of severe VA was defined as sustained and/or hemodynamically unstable ventricular tachycardia (VT), inducible sustained VT, or sudden death of presumed arrhythmic etiology. A total of 21 patients (mean age 16.2 ± 2.1 years; 66.7% male) underwent PPVI. The majority of patients (N = 15; 71.4%) had tetralogy of Fallot (TOF) or TOF-like physiology, with the most common indication being pulmonary insufficiency (N = 10; 47.6%). During a median follow-up of 29.6 months (IQR 10.9–44.0), severe VA occurred in 3 (14.3%) patients aged 15.6 (IQR 14.7–16.1) a median of 12.3 months (IQR 11.2–22.3) after PPVI. All events occurred in patients with TOF-like physiology following Melody valve implant. In conclusion, severe VA can occur long after PPVI in a pediatric population, particularly in those with TOF-like physiology. Further studies are required to elucidate underlying mechanisms and assess strategies to mitigate risks.

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Section: Discussionmentioning

confidence: 99%

Ventricular Arrhythmias and Sudden Death Following Percutaneous Pulmonary Valve Implantation in Pediatric Patients

et al. 2022

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“…Our data show a lower in-hospital and 30-day mortality of TPVR, though 30-day mortality lacks significant between-group differences. The likely explanation for this finding could be that TPVR is less invasive on account of a smaller incision, shorter procedural time and no need for cardiopulmonary bypass (CPB), and that subsequently reduces the potential ischemiareperfusion injury and inflammatory and arrhythmogenic effects caused by CPB (22,24). As for 30-day mortality, perhaps a low enough mortality of SPVR at this time point makes it extremely difficult for TPVR to improve upon it.…”

Section: Discussionmentioning

confidence: 99%

“…The remaining 26 articles were selected for full-text reading, of which 15 reports that failed to meet the eligibility criteria were eliminated. Consequently, eleven observational studies (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) published between 2005 and 2018 were included in our meta-analysis. None meta-analysis comparing clinical outcomes between TPVR and SPVR has been previously reported.…”

Section: Study Searchmentioning

confidence: 99%

Clinical outcomes of transcatheter versus surgical pulmonary valve replacement: a meta-analysis

Zhou¹,

Xiong²,

Bai³

et al. 2019

J Thorac Dis

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Background: Transcatheter pulmonary valve replacement (TPVR) has currently been a well-established alternative operation method to surgical pulmonary valve replacement (SPVR) in patients with pulmonary valve dysfunction in the form of stenosis and/or regurgitation. We conducted a meta-analysis to evaluate the main clinical outcomes after TPVR and SPVR. Methods: We systematically searched the references of relevant literatures from PubMed and the Cochrane Library published between January 2000 and December 2018 and followed The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) for this study. Results: Eleven studies with 4,364 patients were included in the study. Compared with SPVR, TPVR results in a significant decreased in-hospital mortality [odds ratio (OR): 0.18; 95% confidence interval (CI): 0.03-0.98] and mortality at the longest reported follow-up time point (OR: 0.43; 95% CI: 0.22-0.87), though 30-day mortality (OR: 0.38; 95% CI: 0.11-1.33) has no significant difference between groups. Days of hospital stay [(mean difference (MD): −4.38; 95% CI: −6.24-−2.53] is shorter with TPVR than SPVR.Besides, rates of 30-day readmission (OR: 0.67; 95% CI: 0.50-0.91) and recurrent pulmonary regurgitation (OR: 0.17; 95% CI: 0.07-0.42) are lower with TPVR, whereas postprocedural infective endocarditis (IE) (OR: 4.56; 95% CI: 2.03-10.26) are higher with TPVR. SPVR carries a decreased risk of re-operation (OR: 2.19; 95% CI: 0.62-7.76) though without statistically significance. Conclusions:In conclusion, TPVR is associated with a significantly decreased mortality, a shorter length of hospital-stay, a lower rate of 30-day readmission and recurrent pulmonary regurgitation as compared to SPVR throughout the follow-up duration, whereas SPVR results in a significantly lower rate of postprocedural IE than TPVR. In addition, SPVR carries a decreased risk of re-operation with statistically insignificance.

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“…Similar to previously published data on a surgical cohort, 22% of patients still had an AT event by 5 years after PVR, suggesting that there may be other factors implicated in the development of atrial arrhythmias in this population. Nevertheless, given the associated early benefits from a transcatheter approach, including shorter hospital stay, faster recovery, decreased morbidity/adverse events, reduced 30‐day readmission rates, and overall decrease in the arrhythmia burden in the first 30 days after valve implantation, TC‐PVR should be considered preferentially before S‐PVR among eligible CHD patients, ideally at centers experienced to perform such interventions.…”

Section: Discussionmentioning

confidence: 99%

“…This was a single center, retrospective study design with an analysis of a previously collected database of consecutive patients undergoing TC-PVR or S-PVR at UCLA Medical Center between October 2010 through December 2016. 17 The database included patients during this period because TC-PVR became commercially available in the United States in 2010. Data collection was performed in 2017 and subsequent analysis of the data occurred in 2018.…”

Section: Study Populationmentioning

confidence: 99%

Postoperative and short‐term atrial tachyarrhythmia burdens after transcatheter vs surgical pulmonary valve replacement among congenital heart disease patients

Wadia¹,

Lluri²,

Aboulhosn³

et al. 2019

Congenital Heart Disease

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Objective We examined the atrial tachyarrhythmia (AT) burden among patients with congenital heart disease (CHD) following transcatheter (TC‐) or surgical (S‐) pulmonary valve replacement (PVR). Design/Setting This was a retrospective observational study of patients who underwent PVR from 2010 to 2016 at UCLA Medical Center. Patients Patients of all ages who had prior surgical repair for CHD were included. Patients with a history of congenitally corrected transposition of the great arteries, underwent a hybrid PVR procedure, or had permanent atrial fibrillation (AF) without a concomitant ablation were excluded. Outcome Measures The primary outcome was a time‐to‐event analysis of sustained AT. Sustained ATs were defined as focal AT, intra‐atrial reentrant tachycardia/atrial flutter, or AF lasting at least 30 seconds or terminating with cardioversion or antitachycardia pacing. Results Two hundred ninety‐seven patients (TC‐PVR, n = 168 and S‐PVR, n = 129) were included. During a median follow‐up of 1.2 years, nine events occurred in TC‐PVR group (5%) vs 23 events in S‐PVR group (18%). In the propensity adjusted models, the following factors were associated with significant risk of AT after PVR: history of AT, age at valve implantation, severe right atrial enlargement, and S‐PVR. In the secondary analysis, TC‐PVR was associated with lower adjusted risk of AT events in the postoperative epoch (first 30 days), adjusted IRR 0.31 (0.14‐0.97), P = .03, but similar risk in the short‐term epoch, adjusted IRR 0.64 (0.14‐2.94), P = .57. Conclusion There was an increased risk of AT in the first 30 days following S‐PVR compared to TC‐PVR. Additional factors associated with risk of AT events after PVR were a history of AT, age at valve implantation, and severe right atrial enlargement.

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Ventricular arrhythmia burden after transcatheter versus surgical pulmonary valve replacement

Abstract: Compared with S-PVR, TC-PVR was associated with reduced short-term but comparable mid-term and late-term VA burdens. Risk factors for VA after PVR included a surgical approach, valve implantation into a native RVOT and older age at PVR.

Cited by 8 publications

References 26 publications

Ventricular Arrhythmias and Sudden Death Following Percutaneous Pulmonary Valve Implantation in Pediatric Patients

Ventricular Arrhythmias and Sudden Death Following Percutaneous Pulmonary Valve Implantation in Pediatric Patients

Clinical outcomes of transcatheter versus surgical pulmonary valve replacement: a meta-analysis

Postoperative and short‐term atrial tachyarrhythmia burdens after transcatheter vs surgical pulmonary valve replacement among congenital heart disease patients

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