Risk stratification and clinical outcomes after surgical pulmonary valve replacement

Alexander C. Egbe, William R. Miranda, Sameh M. Said, Sorin V. Pislaru, Patricia A. Pellikka, Barry A. Borlaug, Srikanth Kothapalli, Heidi M. Connolly

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background: To determine if RV volume was predictive of survival and cardiovascular adverse event (CAE) after pulmonary valve replacement (PVR). Methods: We reviewed the MACHD (Mayo Adult Congenital Heart Disease) database for patients with tetralogy of Fallot (TOF) undergoing PVR, 2000–2015. The patients were divided into quartiles based on RV end-diastolic volume index (RVEDVI); those in the lowest quartile (Group A, n = 46) and the top quartile (Group B, n = 42) were selected as the study cohort. Results: In comparison to Group A, Group B patients were older at time of PVR (28 ± 4 vs 33 ± 5 years, P =.011) and had larger RV volumes (RVEDVI 127 [117–138] mL/m2 vs 1 91 [179–208], P <.001; RVESVI 64 [57–73] mL/m2 vs 122 [103–136], P <.001). A total of 28 CAE occurred in 23 patients during 69 (33–94) months follow-up: death (n = 4), heart transplant listing (n = 1), initiation of palliative care (n = 1), heart failure hospitalization (n = 11), stroke (n = 2) and sustained ventricular tachycardia/aborted sudden cardiac death (n = 9). Survival was similar between Groups A and B (95% vs 91% at 10 years, P =.273) but freedom from CAE was significantly lower in Group B (67% vs 36% at 10 years, P =.002). Combination of RVESVI: >95 mL/m2 and tricuspid annular plane systolic excursion/RV systolic pressure (TAPSE/RVSP) <0.4 predicted CAE with sensitivity of 67% and specificity of 92%. Conclusion: Patients undergoing PVR at larger RV volumes had similar survival but more overall CAE. A larger study population with a longer follow-up will be required to determine if early PVR provides survival benefit in the long-term.

Original languageEnglish (US)
Pages (from-to)105-112
Number of pages8
JournalAmerican Heart Journal
StatePublished - Dec 2018
Externally publishedYes

Bibliographical note

Funding Information:
Dr. Egbe is supported by National Heart, Lung, and Blood Institute (NHLBI) grant K23 HL141448–01.

Publisher Copyright:
© 2018 Elsevier Inc.


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