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Congenital heart disease
Original research article
Ventricular arrhythmia burden after transcatheter versus surgical pulmonary valve replacement
  1. Subeer Kanwar Wadia1,
  2. Gentian Lluri1,
  3. Jamil A Aboulhosn1,
  4. Kalyanam Shivkumar2,
  5. Brian L Reemtsen3,
  6. Hillel Laks3,
  7. Reshma M Biniwale3,
  8. Daniel S Levi4,
  9. Morris Salem5,
  10. Jeremy P Moore1
  1. 1 Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
  2. 2 Division of Cardiac Electrophysiology, UCLA Cardiac Arrhythmia Center, Los Angeles, California, USA
  3. 3 Division of Cardiothoracic Surgery, UCLA Mattel Children’s Hospital, Los Angeles, California, USA
  4. 4 Division of Pediatric Cardiology, UCLA Mattel Children’s Hospital, Los Angeles, California, USA
  5. 5 Division of Pediatric Cardiology, Kaiser Permanente, Los Angeles, California, USA
  1. Correspondence to Dr Jeremy P Moore, Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA 90095, USA; JPMoore{at}mednet.ucla.edu

Abstract

Objective Comparative ventricular arrhythmia (VA) outcomes following transcatheter (TC-PVR) or surgical pulmonary valve replacement (S-PVR) have not been evaluated. We sought to compare differences in VAs among patients with congenital heart disease (CHD) following TC-PVR or S-PVR.

Methods Patients with repaired CHD who underwent TC-PVR or S-PVR at the UCLA Medical Center from 2010 to 2016 were analysed retrospectively. Patients who underwent hybrid TC-PVR or had a diagnosis of congenitally corrected transposition of the great arteries were excluded. Patients were screened for a composite of non-intraoperative VA (the primary outcome variable), defined as symptomatic/recurrent non-sustained ventricular tachycardia (VT) requiring therapy, sustained VT or ventricular fibrillation. VA epochs were classified as 0–1 month (short-term), 1–12 months (mid-term) and ≥1 year (late-term).

Results Three hundred and two patients (TC-PVR, n=172 and S-PVR, n=130) were included. TC-PVR relative to S-PVR was associated with fewer clinically significant VAs in the first 30 days after valve implant (adjusted HR 0.20, p=0.002), but similar mid-term and late-term risks (adjusted HR 0.72, p=0.62 and adjusted HR 0.47, p=0.26, respectively). In propensity-adjusted models, S-PVR, patient age at PVR and native right ventricular outflow tract (RVOT) (vs bioprosthetic/conduit outflow tract) were independent predictors of early VA after pulmonary valve implantation (p<0.05 for all).

Conclusion 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.

  • congenital heart disease surgery
  • transcatheter valve interventions
  • ventricular tachycardia
  • pulmonic valve disease

https://doi.org/10.1136/heartjnl-2017-312769

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    Footnotes

    • Contributors All of the authors listed have contributed significantly to this manuscript. SKW and GL collected the data and drafted the manuscript. JAA and JPM conceived and designed the project. KS revised the manuscript and provided a critical review. Finally, DSL, MS, RMB, BLR and HL interpreted their respective data, revised the manuscript and provided final approval for submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval UCLA Institutional Review Board.

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

    • Data sharing statement A database was created for this study and included additional variables not used in this study. Included in the variables are follow-up medications, ECG, echocardiographic findings and atrial arrhythmias. These data are available in a spreadsheet and is shared by the Ahmanson/UCLA Adult Congenital Heart Disease Center.