Ventricular arrhythmia burden after transcatheter versus surgical pulmonary valve replacement.
Subeer Kanwar Wadia, Gentian Lluri, Jamil A Aboulhosn, Kalyanam Shivkumar, Brian L Reemtsen, Hillel Laks, Reshma M Biniwale, Daniel S Levi, Morris Salem, Jeremy P Moore
Author Information
Subeer Kanwar Wadia: Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA.
Gentian Lluri: Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA.
Jamil A Aboulhosn: Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA.
Kalyanam Shivkumar: Division of Cardiac Electrophysiology, UCLA Cardiac Arrhythmia Center, Los Angeles, California, USA.
Brian L Reemtsen: Division of Cardiothoracic Surgery, UCLA Mattel Children's Hospital, Los Angeles, California, USA.
Hillel Laks: Division of Cardiothoracic Surgery, UCLA Mattel Children's Hospital, Los Angeles, California, USA.
Reshma M Biniwale: Division of Cardiothoracic Surgery, UCLA Mattel Children's Hospital, Los Angeles, California, USA.
Daniel S Levi: Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California, USA.
Morris Salem: Division of Pediatric Cardiology, Kaiser Permanente, Los Angeles, California, USA.
Jeremy P Moore: Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA.
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.
