The Heart Center, Nationwide Children's Hospital, Columbus, Ohio.
Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
Catheter Cardiovasc Interv. 2019 Oct 1;94(4):607-617. doi: 10.1002/ccd.28454. Epub 2019 Aug 16.
To investigate whether age and valve size at implant contribute to outcomes after Melody transcatheter pulmonary valve replacement (TPVR).
Patient age and valve size at implant contribute to longevity of surgical pulmonary valves.
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).
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 VO (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%.
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.
https://clinicaltrials.gov/ct2/show/NCT00740870 (NCT00740870), https://clinicaltrials.gov/ct2/show/NCT01186692 (NCT01186692), and https://clinicaltrials.gov/ct2/show/NCT00688571 (NCT00688571).
探讨植入时的年龄和瓣膜大小是否会影响经导管肺动脉瓣置换术（TPVR）后的结果。
患者年龄和植入时的瓣膜大小会影响外科肺动脉瓣的寿命。
所有在三个前瞻性 Melody 瓣膜多中心研究中出院时带有 Melody 瓣膜的患者均纳入研究队列。根据年龄分析急性和时间相关的结果：儿童（≤12 岁）、青少年（13-18 岁）、年轻成年人（19-29 岁）和老年人（≥30 岁）。
49 例儿童、107 例青少年、96 例年轻成年人和 57 例老年人成功植入 Melody 瓣膜。TPVR 治疗的儿童（≤18 岁）比成人（62%比 44%）更有可能因管道狭窄而行 TPVR；儿童的管道最小。TPVR 后，儿科和成年患者的 MRI 显示右心室（RV）大小相似，但成年患者的峰值 VO 预测百分比改善（植入前 58%，植入后 64%，p=0.02）和 FEV1（植入前 69%，植入后 71%，p=0.005）。年龄越小，RVOT 功能障碍、再介入和取出的无风险时间越短。儿童的感染性心内膜炎无风险时间最短（p=0.041），但所有其他组的 5 年感染性心内膜炎无风险率均≥90%。
在 Melody TPVR 后，年龄越小，RVOT 功能障碍、再介入和取出的时间越短。≥13 岁的患者发生感染性心内膜炎和取出的风险低，至 5 年时风险为 5 年。对年龄相关时间结果的更好理解将有助于比较 TPVR 候选者的治疗选择。
https://clinicaltrials.gov/ct2/show/NCT00740870（NCT00740870）、https://clinicaltrials.gov/ct2/show/NCT01186692（NCT01186692）和 https://clinicaltrials.gov/ct2/show/NCT00688571（NCT00688571）。
