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Presentation date

2021

College, Institute, or Department

Pediatrics

Research Mentor

Dr. Jonathan W. Cramer

Abstract

Congenital cardiac diseases involving the pulmonary valve are some of the most common forms of congenital heart disease. Over 85% of patients with CHD now live into adulthood making PVR (pulmonary valve replacement) one of the most ACHD procedures. Outcomes of PVR are well established but can differ by institution which is why it was important to assess our institution to compare to national averages. There are two forms of pulmonary valve replacement: Surgical PVR has been the standard of care for the last several decades. Bioprosthetic valves are traditionally placed through an open sternotomy under cardiopulmonary bypass. Outcomes are generally excellent. Valves vary in structure and make-up, but generally last 10 or more years. Catheter based pulmonary valves have been in existence since the mid 2000s and within our program since early 2010s. Valves are placed under fluoroscopic guidance most commonly within a pre-existing surgically placed valve. Outcomes are generally excellent and have similar outcomes to surgical pulmonary valves.Catheter based PVR for native pulmonary valve disease will soon be available (Harmony) and establishing both surgical and catheter based pulmonary valve replacement will be important for future decision making.

The objectives of this study were to investigate pulmonary valve durability and outcomes in adults seen by the pediatric and adult congenital heart disease program at Children’s Hospital and Nebraska Medicine over since the advent of catheter based PVR. Compare indications and medical comorbidities for patients that undergo a surgical pulmonary valve replacement to those that receive a catheterization procedure.Assess and compare pre- and post-operative statuses of the patients receiving pulmonary valve replacement.

IRB approval was achieved for this study which consisted of retrospective cross-sectional chart review with the Inclusion criteria: ACHD patients ≥18 years who underwent pulmonary valvereplacement either through surgical or catheterization intervention in the last 10 years. Patients were reviewed and described. Valve longevity, endocarditis, extubated in the operating room, reoperation, readmittance, and complications were assessed. Duration is calculated using the day of the valve replacement and the last known clinic date. Pulmonary stenosis, pulmonary regurgitation, and mixed valve disease are indicated using Echocardiograms and Cardiac MRI’s when present at the clinic date prior to the procedure and the most recent cardiac clinic date. From this research it is concluded that Surgical PVR are highly successful with low mortality rates, low valve failures, and generally short hospital length of stay. Procedural complications are low and valve failure is rare. Catheterization procedures are also highly successful and have a significantly shorter length of stay, have a higher extubated in the operating room rate, low mortality rate, and low valve failure. Endocarditis has been previously published as higher for catheterization PVRs but for this institution the endocarditis rate is low for both surgical and catheterization. Catheterization pulmonary valve replacement is proven to be effective and should be used as the 1st recommendation for those that qualify for that type of intervention.

Keywords

pulmonary valve replacement, adult congenital heart disease, catheterization, endocarditis, valve longevity

Outcomes Of Pulmonary Valve Replacement in Adult Congenital Heart Disease

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