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Outcomes After Pediatric Pulmonary Valve Replacement in Patients With Tetralogy of Fallot
Louis-Olivier Roy1, Samuel Blais1, Ariane Marelli2
1Department of Pediatrics, Université de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
Insights
Pediatric pulmonary valve replacement (PVR) in tetralogy of Fallot patients under 18 increases cardiac hospitalizations. This study found pediatric PVR was not linked to better outcomes regarding hospitalizations, interventions, or mortality.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiac Valve Repair and Replacement
Background:
- Tetralogy of Fallot repair may necessitate a transannular patch, potentially causing pulmonary valve regurgitation.
- Pulmonary valve replacement (PVR) is used to manage chronic pulmonary regurgitation, but optimal timing is debated.
- Pediatric PVR is a surgical option for young patients with congenital heart defects.
Purpose of the Study:
- To evaluate the association between PVR in patients under 18 years old and subsequent hospitalization, intervention, and mortality rates.
- To analyze the impact of early PVR on long-term outcomes in tetralogy of Fallot patients.
- To investigate the risks and benefits of pediatric PVR.
Main Methods:
- Retrospective observational cohort study of tetralogy of Fallot patients born in Québec (1982-2015).
- Utilized clinical and administrative data, employing marginal means, rates models, and survival curves.
- Inverse probability of treatment weighting was used to balance groups receiving pediatric PVR versus those who did not.
Main Results:
- Of 316 patients, 18.4% underwent pediatric PVR.
- Pediatric PVR was associated with increased cardiac hospitalizations (HR=4.71) but low overall rates.
- No significant differences were observed in all-cause hospitalizations (HR=0.95) or cardiac interventions (HR=1.13).
Conclusions:
- Pediatric PVR in tetralogy of Fallot patients is linked to higher cardiac hospitalization rates.
- Outcomes regarding all-cause hospitalizations, cardiac procedures, and mortality were similar between groups.
- This observational study suggests pediatric PVR is not associated with improved outcomes.
Background:
People with tetralogy of Fallot might require a transannular patch during primary repair, which leads to pulmonary valve regurgitation. Pulmonary valve replacement (PVR) is performed to prevent complications of chronic pulmonary regurgitation, but the optimal timing of PVR remains a matter of debate. In this study we aimed to assess the association of PVR performed in children younger than 18 years of age with the rate of hospitalizations, interventions, and mortality.
Methods:
This was a retrospective observational cohort of people with tetralogy of Fallot born in Québec between 1982 and 2015, using a combination of clinical and administrative data. Marginal means and rates models and survival curves were used to compare outcomes of patients with pediatric PVR (younger than 18 years) and those without. Outcomes of interest were rates of cardiac hospitalizations, all-cause hospitalizations, cardiac interventions, and mortality. Groups were balanced using models weighed on the inverse probability of receiving pediatric PVR.
Results:
Of the 316 eligible patients, 58 (18.4%) received a pediatric PVR. Compared with patients who did not receive pediatric PVR, they were at increased risk of cardiac hospitalizations, although the rates of cardiac hospitalization were low: 0.50 vs 0.09 hospitalizations per 20 years (hazard ratio [HR] = 4.71 [95% confidence interval (CI), 2.22-9.96]). Patients who received a pediatric PVR had a comparable risk of all-cause hospitalizations (HR = 0.95 [95% CI, 0.71-1.26]) and of cardiac interventions (HR = 1.13 [95% CI, 0.72-1.77]).
Conclusions:
Patients who underwent pediatric PVR had higher rates of cardiac hospitalizations, but similar rates of all-cause hospitalizations, cardiac procedures, and mortality. In this observational cohort, pediatric PVR was not associated with an improved outcome.
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