Aimee K Armstrong1, Felix Berger2,3, Thomas K Jones4, John W Moore5, Lee N Benson6, John P Cheatham1, Daniel R Turner7, John F Rhodes8, Julie A Vincent9, Thomas Zellers10, Te-Hsin Lung11, Andreas Eicken12, Doff B McElhinney13. 1. The Heart Center, Nationwide Children's Hospital, Columbus, Ohio. 2. Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. 3. German Center of Cardiovascular Research, Berlin, Germany. 4. Department of Cardiology, Seattle Children's Hospital, Seattle, Washington. 5. Division of Cardiology, Department of Pediatrics, Rady Children's Hospital and University of California San Diego, San Diego, California. 6. The Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Canada. 7. Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan. 8. Department of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina. 9. Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York. 10. Division of Cardiology, Department of Pediatrics, University of Texas Southwestern and the Heart Center at Children's Health, Dallas, Texas. 11. Coronary and Structural Heart Clinical Department, Santa Rosa, California. 12. Deutsches Herzzentrum München, Klinik für Kinderkardiologie und angeborene Herzfehler, Technische Universität München, Munich, Germany. 13. Department of Cardiothoracic Surgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
Abstract
OBJECTIVES: To investigate whether age and valve size at implant contribute to outcomes after Melody transcatheter pulmonary valve replacement (TPVR). BACKGROUND: Patient age and valve size at implant contribute to longevity of surgical pulmonary valves. METHODS: All patients discharged with a Melody valve in the pulmonary position, as part of three prospective Melody valve multicenter studies, comprised the study cohort. Acute and time-related outcomes were analyzed according to age: children (≤12 years), adolescents (13-18 years), young adults (19-29 years), and older adults (≥30 years). RESULTS: Successful Melody valve implantation occurred in 49 children, 107 adolescents, 96 young adults, and 57 older adults. Pediatric patients (≤18 years) were more likely to have TPVR for conduit stenosis than adults (62% vs. 44%); children had the smallest conduits. After TPVR, pediatric and adult patients had similar decreases in right ventricular (RV) size by MRI, but adults had improved percentage predicted peak VO2 (58% preimplant to 64% postimplant, p = .02) and FEV1 (69% pre to 71% post, p = .005). Younger age was associated with shorter freedom from RVOT dysfunction, reintervention, and explant. Children had the shortest freedom from endocarditis (p = .041), but all other groups had 5-year freedom from endocarditis of ≥90%. CONCLUSIONS: Younger age was associated with shorter time to RVOT dysfunction, reintervention, and explant after Melody TPVR. Patients ≥13 years of age were at low risk for endocarditis and explant to 5 years. A better understanding of time-related outcomes by age will aid in the comparison of therapeutic options for TPVR candidates. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT00740870 (NCT00740870), https://clinicaltrials.gov/ct2/show/NCT01186692 (NCT01186692), and https://clinicaltrials.gov/ct2/show/NCT00688571 (NCT00688571).
OBJECTIVES: To investigate whether age and valve size at implant contribute to outcomes after Melody transcatheter pulmonary valve replacement (TPVR). BACKGROUND:Patient age and valve size at implant contribute to longevity of surgical pulmonary valves. METHODS: All patients discharged with a Melody valve in the pulmonary position, as part of three prospective Melody valve multicenter studies, comprised the study cohort. Acute and time-related outcomes were analyzed according to age: children (≤12 years), adolescents (13-18 years), young adults (19-29 years), and older adults (≥30 years). RESULTS: Successful Melody valve implantation occurred in 49 children, 107 adolescents, 96 young adults, and 57 older adults. Pediatric patients (≤18 years) were more likely to have TPVR for conduit stenosis than adults (62% vs. 44%); children had the smallest conduits. After TPVR, pediatric and adult patients had similar decreases in right ventricular (RV) size by MRI, but adults had improved percentage predicted peak VO2 (58% preimplant to 64% postimplant, p = .02) and FEV1 (69% pre to 71% post, p = .005). Younger age was associated with shorter freedom from RVOT dysfunction, reintervention, and explant. Children had the shortest freedom from endocarditis (p = .041), but all other groups had 5-year freedom from endocarditis of ≥90%. CONCLUSIONS: Younger age was associated with shorter time to RVOT dysfunction, reintervention, and explant after Melody TPVR. Patients ≥13 years of age were at low risk for endocarditis and explant to 5 years. A better understanding of time-related outcomes by age will aid in the comparison of therapeutic options for TPVR candidates. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT00740870 (NCT00740870), https://clinicaltrials.gov/ct2/show/NCT01186692 (NCT01186692), and https://clinicaltrials.gov/ct2/show/NCT00688571 (NCT00688571).
Authors: Dietmar Boethig; Murat Avsar; Ulrike M M Bauer; Samir Sarikouch; Philipp Beerbaum; Felix Berger; Robert Cesnjevar; Ingo Dähnert; Sven Dittrich; Peter Ewert; Axel Haverich; Jürgen Hörer; Martin Kostelka; Joachim Photiadis; Eugen Sandica; Stephan Schubert; Aleksandra Urban; Dmitry Bobylev; Alexander Horke Journal: Interact Cardiovasc Thorac Surg Date: 2022-01-18
Authors: Thomas K Jones; Doff B McElhinney; Julie A Vincent; William E Hellenbrand; John P Cheatham; Darren P Berman; Evan M Zahn; Danyal M Khan; John F Rhodes; Shicheng Weng; Lisa J Bergersen Journal: Circ Cardiovasc Interv Date: 2021-12-21 Impact factor: 6.546