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Zampi JD, Heinrich KP, Bergersen L, Goldstein BH, Batlivala SP, Fuller S, Glatz AC, O'Byrne ML, Marino B, Afton K, Lowery R, Yu S, Goldberg CS. Neurocognitive function and health-related quality of life in adolescents and young adults with CHD with pulmonary valve dysfunction. Cardiol Young 2023:1-8. [PMID: 38031461 DOI: 10.1017/s1047951123003979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND Neurocognitive impairment and quality of life are two important long-term challenges for patients with complex CHD. The impact of re-interventions during adolescence and young adulthood on neurocognition and quality of life is not well understood. METHODS In this prospective longitudinal multi-institutional study, patients 13-30 years old with severe CHD referred for surgical or transcatheter pulmonary valve replacement were enrolled. Clinical characteristics were collected, and executive function and quality of life were assessed prior to the planned pulmonary re-intervention. These results were compared to normative data and were compared between treatment strategies. RESULTS Among 68 patients enrolled from 2016 to 2020, a nearly equal proportion were referred for surgical and transcatheter pulmonary valve replacement (53% versus 47%). Tetralogy of Fallot was the most common diagnosis (59%) and pulmonary re-intervention indications included stenosis (25%), insufficiency (40%), and mixed disease (35%). There were no substantial differences between patients referred for surgical and transcatheter therapy. Executive functioning deficits were evident in 19-31% of patients and quality of life was universally lower compared to normative sample data. However, measures of executive function and quality of life did not differ between the surgical and transcatheter patients. CONCLUSION In this patient group, impairments in neurocognitive function and quality of life are common and can be significant. Given similar baseline characteristics, comparing changes in neurocognitive outcomes and quality of life after surgical versus transcatheter pulmonary valve replacement will offer unique insights into how treatment approaches impact these important long-term patient outcomes.
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Affiliation(s)
- Jeffrey D Zampi
- Department of Pediatrics, University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | | | - Lisa Bergersen
- Division of Pediatric Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Bryan H Goldstein
- UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, Heart Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Stephanie Fuller
- Division of Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew C Glatz
- Division of Pediatric Cardiology, St. Louis Children's and Washington University Heart Center, St. Louis, MO, USA
| | - Michael L O'Byrne
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bradley Marino
- Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katherine Afton
- Department of Pediatrics, University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Ray Lowery
- Department of Pediatrics, University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Sunkyung Yu
- Department of Pediatrics, University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Caren S Goldberg
- Department of Pediatrics, University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
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Ligon RA, Latson LA, Ruzmetov MM, Hernandez LE. Right ventricular outflow tract landing zone perimeter / circularised diameter - new imaging standards in pulmonary valve replacement reporting. Cardiol Young 2023; 33:1840-1845. [PMID: 36259096 DOI: 10.1017/s1047951122003286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
- R Allen Ligon
- Division of Pediatric and Adult Congenital Cardiology, The Pediatric Heart Institute, Joe DiMaggio Children's Hospital, 1150 North 35 Avenue, Suite 490, Hollywood, FL, USA
| | - Larry A Latson
- Division of Pediatric and Adult Congenital Cardiology, The Pediatric Heart Institute, Joe DiMaggio Children's Hospital, 1150 North 35 Avenue, Suite 490, Hollywood, FL, USA
| | - Mark M Ruzmetov
- Division of Pediatric and Adult Congenital Cardiology, The Pediatric Heart Institute, Joe DiMaggio Children's Hospital, 1150 North 35 Avenue, Suite 490, Hollywood, FL, USA
| | - Lazaro E Hernandez
- Division of Pediatric and Adult Congenital Cardiology, The Pediatric Heart Institute, Joe DiMaggio Children's Hospital, 1150 North 35 Avenue, Suite 490, Hollywood, FL, USA
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Acute and short-term haemodynamic impact of transcatheter pulmonary valve implantation on left ventricular systolic and diastolic function. Cardiol Young 2021; 31:1835-1841. [PMID: 33722314 DOI: 10.1017/s1047951121001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Assess the acute and short-term haemodynamic impact of transcatheter pulmonary valve implantation on left ventricular systolic and diastolic function stratified by pre-transcatheter pulmonary valve implantation physiology. BACKGROUND Transcatheter pulmonary valve implantation is a widely available option to treat residual or recurrent pulmonary stenosis and pulmonary insufficiency. Transcatheter pulmonary valve implantation acutely increases pulmonary artery size and diastolic pressure in patients with pulmonary insufficiency and acute pulmonary edema has been reported after transcatheter pulmonary valve implantation, possibly related to acute left ventricular volume loading. However, the impact of transcatheter pulmonary valve implantation on left ventricular diastolic function has not been established. METHODS Patients who underwent transcatheter pulmonary valve implantation from 2010 to 2017 at our centre were grouped by indication for transcatheter pulmonary valve implantation as pulmonary stenosis, pulmonary insufficiency, or mixed disease. Separate analysis was performed on those who underwent transcatheter pulmonary valve implantation for pulmonary stenosis versus pulmonary insufficiency or mixed disease. Intracardiac haemodynamics immediately before and after transcatheter pulmonary valve implantation and echocardiographic assessment of left ventricular systolic and diastolic function at baseline, 1-day post transcatheter pulmonary valve implantation, and 1-year post transcatheter pulmonary valve implantation were compared between groups. RESULTS In 102 patients who underwent transcatheter pulmonary valve implantation, the indication was pulmonary stenosis in 29 (28%), pulmonary insufficiency in 28 (29%), and mixed disease in 44 (43%). There were no significant differences in left ventricular systolic or diastolic function between groups at baseline, immediately after transcatheter pulmonary valve implantation, or 1-year post implantation. The mean pulmonary artery wedge pressure increased equally across groups. CONCLUSIONS While patients with pulmonary insufficiency likely have acute left ventricular volume loading following transcatheter pulmonary valve implantation, this does not appear to be haemodynamically significant as transcatheter pulmonary valve implantation was not associated with measurable changes in left ventricular systolic or diastolic function acutely or 1-year post implantation.
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Ribeiro JM, Teixeira R, Lopes J, Costa M, Pires A, Gonçalves L. Transcatheter Versus Surgical Pulmonary Valve Replacement: A Systemic Review and Meta-Analysis. Ann Thorac Surg 2020; 110:1751-1761. [PMID: 32268142 DOI: 10.1016/j.athoracsur.2020.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transcatheter pulmonary valve replacement (TPVR) has emerged as an alternative to surgery in patients with pulmonary valve dysfunction. METHODS We searched the Medline and Cochrane databases since their inception to January 2019 as well as references from article, for all publications comparing TPVR with surgical PVR (SPVR). Studies were considered for inclusion if they reported comparative data regarding any of the study endpoints. The primary endpoint was early mortality after PVR. Secondary endpoints included procedure-related complications, length of hospital stay, mortality during follow-up, infective endocarditis, need for reintervention, post-PVR transpulmonary peak systolic gradient, and significant pulmonary regurgitation. RESULTS There were no differences in perioperative mortality between groups (0.2% vs 1.2%; pooled odds ratio, 0.56; 95% confidence interval, 0.19-1.59; P = .27, I2 = 0%). However TPVR conferred a significant reduction in procedure-related complications and length of hospital stay compared with SPVR. Midterm mortality and the need for repeat intervention were similar with both techniques, but pooled infective endocarditis was significantly more frequent in the TPVR group (5.8 vs 2.7%; pooled odds ratio, 3.09; 95% confidence interval, 1.89-5.06; P < .001, I2 = 0%). TPVR was associated with less significant PR and a trend towards a lower transpulmonary systolic gradient during follow-up. CONCLUSIONS TPVR is a safe alternative to SPVR in selected patients and is associated with a shorter length of hospital stay and fewer procedure-related complications. At midterm follow-up TPVR was comparable with SPVR in terms of mortality and repeat intervention but was associated with an increased risk of infective endocarditis.
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Affiliation(s)
- Joana Maria Ribeiro
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Rogério Teixeira
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - João Lopes
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marco Costa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - António Pires
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; Serviço de Cardiologia Pediátrica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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Wadia SK, Lluri G, Aboulhosn JA, Laks H, Biniwale RM, Van Arsdell GS, Levi DS, Salem MM, Shannon KM, Moore JP. Postoperative and short-term atrial tachyarrhythmia burdens after transcatheter vs surgical pulmonary valve replacement among congenital heart disease patients. CONGENIT HEART DIS 2019; 14:838-845. [PMID: 31282099 DOI: 10.1111/chd.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/29/2019] [Accepted: 06/16/2019] [Indexed: 11/26/2022]
Abstract
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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Affiliation(s)
- Subeer K Wadia
- Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Gentian Lluri
- Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Jamil A Aboulhosn
- Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Hillel Laks
- Division of Cardiothoracic Surgery, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Reshma M Biniwale
- Division of Cardiothoracic Surgery, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Glen S Van Arsdell
- Division of Cardiothoracic Surgery, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Daniel S Levi
- Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Los Angeles, California
| | - Morris M Salem
- Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Los Angeles, California
| | - Kevin M Shannon
- Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.,Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Los Angeles, California
| | - Jeremy P Moore
- Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.,Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, Los Angeles, California
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