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Transcatheter Pulmonary Valve Replacement in Middle and Late Adulthood
John D'Angelo1, John Lisko2, Vasilis C Babaliaros3
1Division of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia.
The American Journal of Cardiology
|August 15, 2024
Summary
Transcatheter pulmonary valve replacement (TPVR) in adults over 40 with congenital heart disease shows favorable short-term and midterm survival. However, right ventricular dysfunction persists, indicating a need to optimize TPVR timing in this growing patient population.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Interventional Cardiology
Background:
- Adult congenital heart disease (ACHD) survival is improving, increasing the need for pulmonary valve interventions.
- Transcatheter pulmonary valve replacement (TPVR) is a common procedure for ACHD patients requiring pulmonary valve intervention.
Purpose of the Study:
- To evaluate the short-term and midterm clinical outcomes of TPVR in patients aged 40 years and older.
- To identify risk factors affecting survival after TPVR in this specific age group.
Main Methods:
- Retrospective cohort study of 67 patients aged ≥40 years who underwent TPVR between 2012 and 2024.
- Utilized descriptive analyses, Kaplan-Meier survival analysis, and Cox proportional hazard modeling.
- Assessed outcomes including survival, complications, and right ventricular function.
Main Results:
- Median age at TPVR was 48 years; median follow-up was 3.5 years.
- 1-, 3-, and 5-year survival rates were 95%, 91%, and 82%, respectively.
- Inpatient status prior to TPVR was a significant negative predictor of survival (HR 24.7, p=0.002).
Conclusions:
- TPVR demonstrates favorable periprocedural and midterm outcomes in patients aged ≥40 years with ACHD.
- Right ventricular dysfunction did not significantly improve post-TPVR.
- Further research is needed to determine the optimal timing for TPVR in older ACHD patients.
