Adverse Events, Radiation Exposure, and Reinterventions Following Transcatheter Pulmonary Valve Replacement

Bryan H. Goldstein, Lisa Bergersen, Aimee K. Armstrong, Brian A. Boe, Howaida El-Said, Diego Porras, Shabana Shahanavaz, Ryan A. Leahy, Jacqueline Kreutzer, Jeffrey D. Zampi, Michael R. Hainstock, Todd M. Gudausky, George T. Nicholson, Kimberlee Gauvreau, Andrea Goodman, Christopher J. Petit

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Transcatheter pulmonary valve replacement (TPVR) is associated with a risk of procedural serious adverse events (SAE) and exposure to ionizing radiation. Objectives: The purpose of this study was to define the risk of, and associations with, SAE and high-dose radiation exposure using large-scale registry data. Methods: The analysis of the multicenter C3PO-QI registry was limited to patients who underwent TPVR from January 1, 2014, to December 31, 2016. SAE were defined as the occurrence of ≥1 moderate, major, or catastrophic events. Radiation dose was reported as dose area product adjusted for weight. Associations with outcome measures were explored in univariate and multivariable analyses. Results: A total of 530 patients (59% male) underwent TPVR at a median age of 18.3 years (interquartile range [IQR]: 12.9 to 27.3 years) and weight of 58 kg (IQR: 43 to 77 kg) at 14 centers. Implant substrate included homograft (41%), bioprosthesis (30%), native right ventricular outflow tract (RVOT) (27%) and other (2%). TPVR indications were pulmonary insufficiency (28%), stenosis (23%), and mixed (49%). AE and SAE occurred in 26% and 13% of cases, respectively, including 1 mortality. SAE were more frequent in homograft conduit than other RVOT substrates, although SAE type and severity differed between implant substrates. Median radiation dose was 198 μGy·m2/kg (IQR: 94 to 350 μGy·m2/kg). Higher radiation dose was associated with older age, greater RVOT obstruction, and concomitant interventions (p < 0.001). During a median follow-up duration of 1 year, 13.3% underwent catheterization, surgery, or both, unrelated to infection. Younger age, smaller size, and hemodynamic and anatomic factors indicative of greater RVOT obstruction were associated with TPV reintervention. Conclusions: The incidence of SAE during TPVR in the C3PO-QI registry is high, but mortality is uncommon. Radiation dose is greater than for other congenital interventions and is associated with patient and procedural factors. Reintervention is common during early follow-up.

Original languageEnglish
Pages (from-to)363-376
Number of pages14
JournalJournal of the American College of Cardiology
Volume75
Issue number4
DOIs
StatePublished - Feb 4 2020

Keywords

  • adverse events
  • congenital heart disease
  • dose area product
  • infective endocarditis outcomes research
  • tetralogy of Fallot
  • transcatheter PVR

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