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Calvert PA, Northridge DB, Malik IS, Shapiro L, Ludman P, Qureshi SA, Mullen M, Henderson R, Turner M, Been M, Walsh KP, Casserly I, Morrison L, Walker NL, Thomson J, Spence MS, Mahadevan VS, Hoye A, MacCarthy PA, Daniels MJ, Clift P, Davies WR, Adamson PD, Morgan G, Aggarwal SK, Ismail Y, Ormerod JOM, Khan HR, Chandran SS, de Giovanni J, Rana BS, Ormerod O, Hildick-Smith D. Percutaneous Device Closure of Paravalvular Leak: Combined Experience From the United Kingdom and Ireland. Circulation 2016; 134:934-44. [PMID: 27587432 DOI: 10.1161/circulationaha.116.022684] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paravalvular leak (PVL) occurs in 5% to 17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to repeat surgery. METHODS All UK and Ireland centers undertaking percutaneous PVL closure submitted data to the UK PVL Registry. Data were analyzed for association with death and major adverse cardiovascular events (MACE) at follow-up. RESULTS Three hundred eight PVL closure procedures were attempted in 259 patients in 20 centers (2004-2015). Patient age was 67±13 years; 28% were female. The main indications for closure were heart failure (80%) and hemolysis (16%). Devices were successfully implanted in 91% of patients, via radial (7%), femoral arterial (52%), femoral venous (33%), and apical (7%) approaches. Nineteen percent of patients required repeat procedures. The target valve was mitral (44%), aortic (48%), both (2%), pulmonic (0.4%), or transcatheter aortic valve replacement (5%). Preprocedural leak was severe (61%), moderate (34%), or mild (5.7%) and was multiple in 37%. PVL improved postprocedure (P<0.001) and was none (33.3%), mild (41.4%), moderate (18.6%), or severe (6.7%) at last follow-up. Mean New York Heart Association class improved from 2.7±0.8 preprocedure to 1.6±0.8 (P<0.001) after a median follow-up of 110 (7-452) days. Hospital mortality was 2.9% (elective), 6.8% (in-hospital urgent), and 50% (emergency) (P<0.001). MACE during follow-up included death (16%), valve surgery (6%), late device embolization (0.4%), and new hemolysis requiring transfusion (1.6%). Mitral PVL was associated with higher MACE (hazard ratio [HR], 1.83; P=0.011). Factors independently associated with death were the degree of persisting leak (HR, 2.87; P=0.037), New York Heart Association class (HR, 2.00; P=0.015) at follow-up and baseline creatinine (HR, 8.19; P=0.001). The only factor independently associated with MACE was the degree of persisting leak at follow-up (HR, 3.01; P=0.002). CONCLUSION Percutaneous closure of PVL is an effective procedure that improves PVL severity and symptoms. Severity of persisting leak at follow-up is independently associated with both MACE and death. Percutaneous closure should be considered as an alternative to repeat surgery.
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Affiliation(s)
- Patrick A Calvert
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.).
| | - David B Northridge
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Iqbal S Malik
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Leonard Shapiro
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Peter Ludman
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Shakeel A Qureshi
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Michael Mullen
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Robert Henderson
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Mark Turner
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Martin Been
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Kevin P Walsh
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Ivan Casserly
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Lindsay Morrison
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Nicola L Walker
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - John Thomson
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Mark S Spence
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Vaikom S Mahadevan
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Angela Hoye
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Philip A MacCarthy
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Matthew J Daniels
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Paul Clift
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - William R Davies
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Philip D Adamson
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Gareth Morgan
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Suneil K Aggarwal
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Yasmin Ismail
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Julian O M Ormerod
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Habib R Khan
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Sujay Subash Chandran
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Joseph de Giovanni
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Bushra S Rana
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - Oliver Ormerod
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
| | - David Hildick-Smith
- From Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (P.A.C., L.S., W.R.D., B.S.R.); Queen Elizabeth Hospital, University Hospitals Birmingham, United Kingdom (P.A.C., P.L., P.C., J.d.G.); Institute of Translational Medicine, University of Birmingham, United Kingdom (P.A.C., P.C.); Royal Infirmary of Edinburgh, Edinburgh, United Kingdeom (D.B.N.); Imperial College NHS Trust, London, United Kingdom (I.S.M.); Evelina Children's Hospital, London, United Kingdom (S.A.Q., G.M.); The Heart Hospital, London, United Kingdom (M.M.); Nottingham University Hospital, Nottingham, United Kingdom (R.H., H.R.K.); Bristol Heart Institute, Bristol, United Kingdom (M.T., Y.I.); University Hospital Coventry, Coventry, United Kingdom (M.B.); Mater Misericordiae University Hospital, Dublin, Ireland (K.P.W.); Mater Private Hospital, Dublin, Ireland (I.C.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (L.M., S.K.A.); Golden Jubilee National Hospital, Glasgow, United Kingdom (N.L.W.); Leeds General Infirmary, Leeds, United Kingdom (J.T.); Royal Victoria Hospital, Belfast, United Kingdom (M.S.S.); Manchester Royal Infirmary, Manchester, United Kingdom (V.S.M.); Castle Hill Hospital, Hull, United Kingdom (A.H.); King's College London, United Kingdom (P.A.M.); John Radcliffe Hospital, Oxford, United Kingdom (M.J.D., J.O.M.O., O.O.); and Royal Sussex County Hospital, Brighton, United Kingdom (S.S.C., D.H.-S.)
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