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Transcatheter pulmonary-valve replacement, surgery appear to have comparable outcomes

Reuters Health - 14/01/2022 - Patients who undergo transcatheter pulmonary-valve replacement (TPVR) face similar odds of surviving and not needing reintervention or surgery as those who undergo surgical conduit or valve replacement, according to new findings.

"The cumulative incidence of death and repeated intervention after TPVR is related to age at implant and is comparable to that in patients undergoing surgical pulmonary valve replacement," the authors write in Journal of the American College of Cardiology.

To investigate mid- and long-term outcomes after TPVR, Dr. Doff B. McElhinney of Stanford University School of Medicine in Palo Alto, California, and his colleagues analyzed data from an international registry containing data on time-related outcomes after TPVR. The registry included 2,476 patients between 14 and 58 years of age who underwent TPVR and were followed up for 8,475 patient-years.

After TPVR, 95 patients died, 24 from heart failure. Eight years after TPVR, the cumulative incidence of death was 8.9%. On multivariable analysis, age at TPVR (hazard ratio, 1.04 per year; P<0.001), a prosthetic valve in other positions (HR, 2.1; P=0.014), and an existing transvenous pacemaker or implantable cardioverter-defibrillator (HR, 2.1; P=0.004) were linked with death.

A total of 258 patients underwent TPV reintervention. The cumulative incidence at eight years of any TPV reintervention was 25.1%, and that of surgical valve replacement was 14.4%.

Risk factors for surgical reintervention included age (HR, 0.95 per year; P<0.001), prior endocarditis (HR, 2.5; P=0.001), TPVR into a stented bioprosthetic valve (HR, 1.7; P=0.007), and postimplant gradient (HR, 1.4 per 10 mm Hg; P<0.001).

"Although this study cannot be compared directly with results of published surgical series or with other studies of TPVR for various reasons," the authors write, "we believe that the findings of this analysis support the conclusion that survival and freedom from RVOT (right ventricular outflow tract) reintervention or surgery after TPVR are generally comparable to outcomes of surgical conduit or valve replacement across a wide range of patient ages."

"This is clearly a complex population that is at risk for premature death beyond procedural or reintervention-related mortality, which were minor contributors to the reduced survival in this cohort," they explain.

"Additional investigation is necessary to elucidate the long-term impact of TPVR on survival, particularly in adults," the authors conclude.

Drs. Alain Fraisse and colleagues at the Royal Brompton Hospital and Harefield National Health Service Foundation Trust, in London, write in an accompanying editorial that the authors "should be congratulated for their performance in analyzing the largest published number of patients undergoing TPVR. Their study assesses numerous variables that are relevant in patient selection and prognostication and optimizes our understanding of TPVR."

Dr. McElhinney and other study authors declare financial involvements with Medtronic or Edwards Lifesciences. Dr. Fraisse reports involvements with Medtronic, Abbott and Occlutech.

SOURCES: https://bit.ly/3nLrZFB and https://bit.ly/3I6AEK6 JACC, online January 4, 2022.

By Reuters Staff

© 2023 The Author(s). Published by Medicom Medical Publishers.
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