Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA.
Division of Cardiac Electrophysiology, UCLA Cardiac Arrhythmia Center, Los Angeles, California, USA.
Heart. 2018 Nov;104(21):1791-1796. doi: 10.1136/heartjnl-2017-312769. Epub 2018 Apr 10.
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.
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).
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).
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.
经导管（TC-PVR）或外科肺动脉瓣置换术（S-PVR）后对比性心室心律失常（VA）结果尚未得到评估。我们旨在比较先天性心脏病（CHD）患者接受 TC-PVR 或 S-PVR 后的 VA 差异。
回顾性分析 2010 年至 2016 年在加州大学洛杉矶分校医疗中心接受 TC-PVR 或 S-PVR 的 CHD 修复患者。排除接受杂交 TC-PVR 或诊断为先天性矫正性大动脉转位的患者。对非手术性 VA 复合症（主要结局变量）进行筛选，定义为需要治疗的有症状/复发性非持续性室性心动过速（VT）、持续性 VT 或心室颤动。VA 期分为 0-1 个月（短期）、1-12 个月（中期）和≥1 年（晚期）。
共纳入 302 例患者（TC-PVR，n=172；S-PVR，n=130）。与 S-PVR 相比，TC-PVR 在瓣膜植入后 30 天内 VA 发生率较低（校正 HR 0.20，p=0.002），但中期和晚期风险相似（校正 HR 0.72，p=0.62 和校正 HR 0.47，p=0.26）。在倾向评分调整模型中，S-PVR、PVR 时患者年龄和原生右心室流出道（RVOT）（而非生物假体/管道流出道）是肺动脉瓣植入后早期 VA 的独立预测因素（所有 p<0.05）。
与 S-PVR 相比，TC-PVR 与短期 VA 减少相关，但中期和晚期 VA 负担相似。PVR 后 VA 的危险因素包括手术方法、原生 RVOT 中的瓣膜植入和 PVR 时的年龄较大。
