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. 2019 Oct 1;94(4):607-617.
doi: 10.1002/ccd.28454. Epub 2019 Aug 16.

Association between patient age at implant and outcomes after transcatheter pulmonary valve replacement in the multicenter Melody valve trials

Aimee K Armstrong  1 , Felix Berger  2   3 , Thomas K Jones  4 , John W Moore  5 , Lee N Benson  6 , John P Cheatham  1 , Daniel R Turner  7 , John F Rhodes  8 , Julie A Vincent  9 , Thomas Zellers  10 , Te-Hsin Lung  11 , Andreas Eicken  12 , Doff B McElhinney  13
Affiliations

Association between patient age at implant and outcomes after transcatheter pulmonary valve replacement in the multicenter Melody valve trials

Aimee K Armstrong et al. Catheter Cardiovasc Interv. .

Abstract

Objectives: To investigate whether age and valve size at implant contribute to outcomes after Melody transcatheter pulmonary valve replacement (TPVR).

Background: Patient age and valve size at implant contribute to longevity of surgical pulmonary valves.

Methods: 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).

Results: 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 VO2 (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%.

Conclusions: 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.

Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT00740870 (NCT00740870), https://clinicaltrials.gov/ct2/show/NCT01186692 (NCT01186692), and https://clinicaltrials.gov/ct2/show/NCT00688571 (NCT00688571).

Keywords: TPVR; tetralogy of Fallot.

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References

REFERENCES

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    1. Askovich B, Hawkins JA, Sower CT, et al. Right ventricle-to-pulmonary artery conduit longevity: is it related to allograft size? Ann Thorac Surg. 2007;84:907-911. discussion 911-2.
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