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Original research article
Early outcomes in patients undergoing transcatheter versus surgical pulmonary valve replacement
  1. Zachary L Steinberg1,
  2. Thomas K Jones2,
  3. Edward Verrier3,
  4. Karen K Stout1,2,
  5. Eric V Krieger4,
  6. Tara Karamlou5
  1. 1 Department of Medicine, University of Washington, Washington, Seattle, USA
  2. 2 Department of Pediatrics, Seattle Children's Hospital, Washington, Seattle, USA
  3. 3 Division of Cardiothoracic Surgery, Department of Surgery, University of Washington School of Medicine, Washington, Seattle, USA
  4. 4 Department of Cardiac Clinic & Services, University of Washington Medical Center, Washington, Seattle, USA
  5. 5 Department of Surgery, Phoenix Children's Hospital, Arizona, Phoenix, USA
  1. Correspondence to Dr Zachary L Steinberg, University of Washington, 1959 NE Pacific Street, Box 356422, Suite AA522, Seattle, WA 98195-6422, USA; zsteinberg{at}cardiology.washington.edu

Abstract

Objectives To identify predictors of morbidity and mortality in patients undergoing either transcatheter pulmonary valve replacement (TPVR) or surgical pulmonary valve replacement (SPVR) in an effort to quantify any early benefit of TPVR over SPVR.

Methods Using a risk-adjusted propensity score model, we compare early major morbidity and mortality between patients undergoing SPVR and TPVR at our institution between January 2006 and January 2014.

Results 145 patients in the SPVR cohort and 78 patients in the TPVR cohort were included. Primary pulmonary regurgitation was more common in the SPVR group (76.6% vs 23.1%, p<0.001) and primary pulmonary stenosis was more common in the TPVR group (9.7% vs 44.9%, p< 0.001). In unadjusted analysis, major morbidity and mortality occurred in 11.7% of SPVR patients versus 3.8% of TPVR patients (p=0.04). However, following risk adjustment and inclusion of a propensity score, no significant difference was seen between the two modalities. A larger right ventricular end-diastolic dimension (RVEDVI) was the only preoperative variable associated with the primary end point (OR 1.013/10 mL/m2 increase, p=0.03). Hospital length of stay was significantly longer in patients undergoing SPVR (6.9±1.0 days SPVR vs 1.2±0.3 days TPVR, p<0.0001), with similar hospital costs between groups (mean: US$44 660±5071 SPVR vs US$48 355±1000 TPVR, p=0.7).

Conclusions Following risk adjustment, no significant differences were observed between SPVR and TPVR strategies. TPVR was associated with a shorter hospitalisation; however, total hospitalisation costs were similar between groups.

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Footnotes

  • Contributors All authors attest that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript.

  • Competing interests TKJ: research grant support, consultant and scientific advisory board for Medtronic. The remaining authors have nothing to disclose.

  • Patient consent This retrospective study did not require patient consent by the IRB. All patient information is de-identified.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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