Percutaneous pulmonary valve implantation: 5 years of follow-up: does age influence outcomes?

Circ Cardiovasc Interv. 2015 Feb;8(2):e001745. doi: 10.1161/CIRCINTERVENTIONS.114.001745.

Percutaneous pulmonary valve implantation: 5 years of follow-up: does age influence outcomes?

Borik S1Crean A1Horlick E1Osten M1Lee KJ1Chaturvedi R1Friedberg MK1McCrindle BW1Manlhiot C1Benson L2.

Comment: In this study, Borik and colleagues seek to determine whether reverse RV remodeling after percutaneous pulmonary valve implantation (PPVI) was persistent in the longer term and whether the timing of PPVI influenced outcomes. They retrospectively reviewed cardiac MRI, echocardiography, and exercise tests on 51 patients who underwent PPVI and were followed for a mean of 4.5 years. The majority of patients (all but 2) had either mixed pulmonary stenosis/regurgitation or predominantly stenosis. They found that for every decade of younger age at implantation there was an increase of 3.9%±1% LV ejection fraction and 2.4±0.9 mL/kg/min in max VO2 (p=0.005) and a decrease of 0.7±0.2cm in RV end-diastolic dimension. They conclude that early PPVI is associated with improved exercise capacity and RV dimensions. While this study shows that younger patients may benefit from PPVI they do not demonstrate improved clinical outcomes and it is important to always consider downsides of earlier implantation (yearly risk of endocarditis and need for repeated PPVI in the future with narrowing of the RVOT). As always, it is important to consider patient specific factors when determining both timing of pulmonary valve replacement and procedure type (surgical vs percutaneous).