Younger age linked to poorer outcomes after pulmonary valve replacement

Young patients with congenital heart disease who underwent pulmonary valve replacement had a higher risk for reintervention than adults, according to data from a retrospective review presented at the American Association for Thoracic Surgery Annual Meeting.

Researchers evaluated surgical and follow-up data on 633 patients with congenital heart disease who underwent pulmonary valve replacement (PVR) using bioprosthetic valves from 1996 to 2014. The median age of the patients at time of surgery was 17.5 years (59% male).

Time to reintervention via surgical or catheter-based PVR was assessed in all patients, and time to deterioration of the structural valve, as indicated by moderate or more severe pulmonary stenosis or regurgitation on echocardiogram, also was assessed in 474 patients. Median follow-up was 2.9 years.

Reintervention was required in 7% of all patients, and reintervention or structural valve deterioration occurred in 23% of those assessed for both outcomes. Researchers observed no association between reintervention or valve deterioration and gender, the method used for valve insertion or the performance of concurrent procedures during valve placement.

Older patients had a reduced risk for reintervention or valve deterioration (HR = 0.9 per 3-year age increase; P = .009). According to a press release, the reintervention rate at 5 years after the procedure was 11% for patients younger than 12 years, 7% for patients aged 12 to 27 years and 0% for those older than 27 years. Other factors associated with younger age, including low BMI, body weight or body surface area, also were linked to increased risk for reintervention.

After adjustment for age, other factors independently associated with risk for reintervention or valve deterioration included the type of valve used (P < .0001) and the labeled valve size (HR = 1.12 per mm decrease in size; P = .017).

In analyses according to the type of valve used, researchers noted that half of patients had received the Mitroflow valve (Sorin), but that the reintervention rate (17.6%) was higher among recipients of this valve than any of the others assessed, including Magna/MagnaEase (Carpentier-Edwards), Perimount (Carpentier-Edwards) and porcine valves (P ≤ .01). The link between patient outcome and type of valve used was not dependent upon patient age (P = .75 for interaction).

“In this comprehensive series, we have identified specific valve type and all measures related to younger patient age at surgery to be important predictors of reintervention,” Christopher W. Baird, MD, from the department of cardiac surgery at Boston Children’s Hospital of Harvard Medical School, said in the release. “Children with low BMI may merit closer monitoring following PVR or nutritional counseling to increase BMI prior to scheduling surgery.” – by Adam Taliercio

Reference:

Nomoto RS, et al. Abstract #47. Presented at: the American Association for Thoracic Surgery Annual Meeting; April 25-29, 2015; Seattle.

Disclosure: Cardiology Today was unable to obtain relevant financial disclosures.