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Multicenter Study
. 2025 Dec;21(12):1045-1051.
doi: 10.1080/14796678.2025.2591511. Epub 2025 Nov 18.

Impact of heart failure on in-hospital outcomes of pulmonary valve interventions: a nationwide analysis

Mohammad Ali Sheffeh  1   2 , Heena Asnani  3 , Ider Oujamaa  1 , Khaled M Harmouch  4 , Mustafa Turkmani  5   6 , Judy Sheffeh  1 , Jawad Basit  7 , Wael AlJaroudi  8 , M Chadi Alraies  9
Affiliations
Multicenter Study

Impact of heart failure on in-hospital outcomes of pulmonary valve interventions: a nationwide analysis

Mohammad Ali Sheffeh et al. Future Cardiol. 2025 Dec.

Abstract

Background: Data on outcomes of surgical pulmonary valve replacement or repair (SPVR/SPVr) in patients with heart failure (HF) are limited. We aimed to assess the safety and complications of SPVR/SPVr in this population.

Methods: Adults (≥18 years) who underwent SPVR/SPVr between 2018-2021 were identified from the National Inpatient Sample. Patients were stratified by HF status. In-hospital outcomes included mortality, cardiac arrest, cardiogenic shock, mechanical ventilation (MV), vasopressor use, heart block, permanent pacemaker (PPM), ECMO, bleeding, and acute kidney injury (AKI). Propensity score matching was performed to adjust for comorbidities, hospital factors, income, and elective status. Logistic regression was used to assess associations between HF and outcomes.

Results: There were 4595 SPVR/SPVr; the median age was 35 (26-52). Patients with heart failure had an increased risk of mortality, odds ratio (OR) 3.42 (95% confidence interval [CI] 1.19-6.12); p-value < 0.0001, heart block 1.75 (1.45-2.13); < 0.0001, bleeding 1.31 (1.12-1.52); 0.0005, AKI 1.35 (1.12-1.61); 0.001, vasopressor use 1.33 (1.08-1.65); 0.007, cardiogenic shock 2.34 (1.87-2.93); < 0.0001, MV 1.45 (1.09-1.94); 0.01, in-hospital cardiac arrest 2.29 (1.35-3.91); 0.002, ECMO 2.23 (1.43-3.45); 0.0003. No significant difference in PPM 1.51 (0.85-2.67); 0.1.

Conclusion: Heart failure is associated with worse in-hospital outcomes following surgical pulmonic valve replacement or repair. Preoperative optimization and considering earlier surgical intervention may improve outcomes in this high-risk population.

Keywords: Pulmonary valve replacement; cardiac surgery; congenital heart disease; heart failure; hospital mortality; postoperative complications; pulmonary valve repair; risk stratification.

Plain language summary

Heart failure is a serious condition where the heart cannot pump blood efficiently. One of the causes of heart failure is weak valves, including the pulmonary valve, which controls blood flow between the heart and the lungs. Pulmonary valve disease sometimes requires intervention by repairing or replacing it to restore normal function and prevent heart failure. In people who need surgery, heart failure can make the surgery riskier. Using a large national database of hospitalizations in the United States, we compared the outcomes of surgery between those with and without heart failure. We found that people with heart failure had higher risks of death, bleeding, kidney problems, and the need for breathing machines or heart-support devices during their hospital stay. These findings suggest that patients with heart failure represent a particularly vulnerable group who may benefit from careful pre-surgical assessment and close monitoring after surgery. Timely pulmonary valve intervention before heart failure develops may help prevent these complications and improve recovery.

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Conflict of interest statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

References

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    2. • This large national registry analysis provides a benchmark for postoperative outcomes in adult congenital heart surgery, serving as a key comparative reference for our study.

    1. Ladouceur M, Bouchardy J.. Epidemiology and definition of heart failure in adult congenital heart disease. Heart Fail Clin. 2024;20(2):113–127. doi: 10.1016/j.hfc.2023.12.001 - DOI - PubMed

    2. • This paper offers an updated overview of how heart failure manifests and is classified in adult congenital heart disease, contextualizing our study’s population.

    3. • This study quantifies the burden and progression of heart failure in congenital heart disease, reinforcing the clinical relevance of our findings.

    1. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 aha/acc guideline for the management of adults with congenital heart disease: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2019;73(12):1494–1563. doi: 10.1016/j.jacc.2018.08.1028 - DOI - PubMed

    2. • These practice guidelines form the foundation for indications and timing of pulmonary valve interventions in congenital heart disease.

    1. Joynt Maddox KE, Elkind MSV, Aparicio HJ, et al. Forecasting the burden of cardiovascular disease and stroke in the United States through 2050-prevalence of risk factors and disease: a presidential advisory from the American Heart Association. Circulation. 2024;150(4):e65–e88. doi: 10.1161/CIR.0000000000001256 - DOI - PubMed
    1. Gilljam T, Mandalenakis Z, Dellborg M, et al. Development of heart failure in young patients with congenital heart disease: a nation-wide cohort study. Open Heart. 2019;6(1):e000858. doi: 10.1136/openhrt-2018-000858 - DOI - PMC - PubMed

    2. •• This national cohort demonstrates the early and progressive development of heart failure in congenital heart disease, reinforcing the importance of early intervention and validating the relevance of HF as a key predictor of adverse surgical outcomes in our study.

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