Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 81(21), 2075–2085. https://doi.org/10.1016/j.jacc.2023.02.052 Dr. Jouke P. Bokma et al.
Points
- This research study investigated the impact of pulmonary valve replacement (PVR) on significant adverse clinical outcomes in patients with repaired tetralogy of Fallot (rTOF).
- Propensity score matching was used to adjust for baseline differences between patients who received PVR and those who did not.
- The primary outcome measure was the occurrence of death or sustained ventricular tachycardia (VT).
- PVR patients had a significantly lower risk of the primary outcome compared to those who did not undergo the procedure.
- Subgroup analysis indicated potential benefits of PVR in patients with advanced right ventricular dilatation, but no significant association was observed in patients with lesser RV dilatation.
Summary
This research study aimed to investigate the impact of pulmonary valve replacement (PVR) on significant adverse clinical outcomes in patients with repaired tetralogy of Fallot (rTOF), a congenital heart defect. The study utilized data from the INDICATOR (International Multicenter TOF Registry). It focused on determining whether PVR is associated with improved survival and freedom from sustained ventricular tachycardia (VT) in rTOF patients.
A propensity score was created to adjust for baseline differences between patients who received PVR and those who did not. The primary outcome measure was the time to the earliest occurrence of death or sustained VT. The analysis involved matching PVR and non-PVR patients 1:1 based on the propensity score (matched cohort) and performing modeling with propensity score as a covariate adjustment in the entire cohort.
Among the 1,143 rTOF patients included in the study, with an average age of 27 years and 47% having received PVR, the primary outcome occurred in 82 individuals. The adjusted hazard ratio (HR) for the primary outcome in the matched cohort (n = 524) was 0.41, indicating a significantly lower risk for PVR patients compared to those who did not undergo the procedure (95% confidence interval [CI]: 0.21-0.81; multivariable model P = 0.010). Similar results were observed in the entire cohort analysis. Subgroup analysis revealed the potential benefits of PVR in patients with advanced right ventricular (RV) dilatation. Specifically, in patients with RV end-systolic volume index >80 mL/m2, PVR was associated with a lower risk of the primary outcome (HR: 0.32; 95% CI: 0.16-0.62; P < 0.001). However, there was no significant association between PVR and the primary outcome in patients with RV end-systolic volume index ≤80 mL/m2 (HR: 0.86; 95% CI: 0.38-1.92; P = 0.70).
In conclusion, this study demonstrated that compared to rTOF patients who did not undergo PVR, those who received PVR had a lower risk of the composite endpoint of death or sustained VT. These findings suggest the potential benefits of PVR in improving outcomes for patients with rTOF, particularly in cases of advanced RV dilatation.
Link to the article: https://www.sciencedirect.com/science/article/pii/S0735109723052324
References Bokma, J. P., Geva, T., Sleeper, L. A., Lee, J. H., Lu, M., Sompolinsky, T., Babu-Narayan, S. V., Wald, R. M., Mulder, B. J. M., & Valente, A. M. (2023). Improved outcomes after pulmonary valve replacement in repaired tetralogy of fallot. Journal of the American College of Cardiology, 81(21), 2075–2085. https://doi.org/10.1016/j.jacc.2023.02.052
