Impact of pulmonary valve replacement on ventricular function and cardiac events in patients with tetralogy of Fallot. A retrospective cohort study.

Autor: Ruperti-Repilado FJ; Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland. Electronic address: javier.ruperti@usb.ch., Haag N; Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Fischer T; Master Program in Biostatistics, University of Zurich, Switzerland., Santos Lopes B; Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Radiology, University Children's Hospital, University of Zurich, Zurich, Switzerland., Meier L; Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Wustmann K; Department of Cardiology, University Hospital Inselspital, University of Bern, Bern, Switzerland., Bonassin F; Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Attenhofer Jost C; Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Schwitz F; Department of Cardiology, University Hospital Inselspital, University of Bern, Bern, Switzerland., Schwerzmann M; Department of Cardiology, University Hospital Inselspital, University of Bern, Bern, Switzerland., Tobler D; Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland. Electronic address: https://twitter.com/@DDaniel_Tobler., von Felten S; Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland., Greutmann M; Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Jazyk: English; Spanish; Castilian
Zdroj: Revista espanola de cardiologia (English ed.) [Rev Esp Cardiol (Engl Ed)] 2024 May; Vol. 77 (5), pp. 408-417. Date of Electronic Publication: 2023 Dec 02.
DOI: 10.1016/j.rec.2023.11.007
Abstrakt: Introduction and Objectives: Our aim was to assess the impact of prosthetic pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF) on changes in biventricular volumes and function and on adverse cardiac events.
Methods: Adults with rTOF were identified from the SACHER-registry. Data from serial cardiac magnetic resonance imaging, echocardiography, exercise capacity and n-terminal pro b-type natriuretic peptide (NT-proBNP) were collected. The primary endpoint was right ventricular ejection fraction (RVEF) as measured by cardiac magnetic resonance. Secondary endpoints were biventricular volumes, left ventricular ejection fraction, exercise capacity and NT-proBNP levels, and time to adverse cardiac outcomes (atrial and ventricular arrhythmia, endocarditis). Associations between previous PVR and longitudinal changes in functional outcomes and time to adverse cardiac outcomes were analyzed using linear mixed-effects models and Cox proportional hazards models, respectively.
Results: A total of 308 patients (153 with and 155 without PVR) with 887 study visits were analyzed. Previous PVR was not significantly associated with changes in RVEF (CE, -1.33; 95%CI, -5.87 to 3.21; P=.566). Previous PVR was associated with lower right ventricular end-diastolic volume but had no significant effect on left ventricular ejection fraction, exercise capacity, or NT-proBNP-levels. Previous PVR was associated with an increased hazard of atrial arrhythmias (HR, 2.09; 95%CI, 1.17-3.72; P=.012) and infective endocarditis (HR, 12.72; 95%CI, 4.69-34.49; P<.0001) but not with an increased hazard of sustained ventricular arrhythmias (HR, 0.64; 95%CI, 0.18-2.27; P=.490).
Conclusions: Previous PVR was not significantly associated with changes in RVEF but was associated with an increased risk of atrial arrhythmias and infective endocarditis.
(Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
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