Preoperative predictors of death and sustained ventricular tachycardia after pulmonary valve replacement in patients with repaired tetralogy of fallot enrolled in the INDICATOR Cohort
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Accepted version
Supporting information
Author(s)
Type
Journal Article
Abstract
Background -Risk factors for adverse clinical outcomes have been identified in patients with repaired tetralogy of Fallot (rTOF) before pulmonary valve replacement (PVR). However, pre-PVR predictors for post-PVR sustained ventricular tachycardia (VT) and death have not been identified. Methods -Patients with rTOF enrolled in the INDICATOR cohort-a 4-center international cohort study- who had a comprehensive preoperative evaluation and subsequently underwent PVR were included. Pre-procedural clinical, electrocardiogram, cardiovascular magnetic resonance (CMR), and postoperative outcome data were analyzed. Cox proportional hazards multivariable regression analysis was used to evaluate factors associated with time from pre-PVR CMR until the primary outcome-death, aborted sudden cardiac death, or sustained VT. Results -Of the 452 eligible patients (median age at PVR 25.8 years), 36 (8%) reached the primary outcome (27 deaths, 2 resuscitated death, and 7 sustained VT) at a median time after PVR of 6.5 years. Cox proportional hazards regression identified pre-PVR right ventricular (RV) ejection fraction < 40% (hazard ratio [HR] 2.39; 95% confidence interval [CI] 1.18 to 4.85; P = 0.02), RV mass-to-volume ratio ≥ 0.45 g/mL (HR 4.08; 95%, CI 1.57 to 10.6; P = 0.004), and age at PVR ≥ 28 years (HR 3.10; 95% CI 1.42 to 6.78; P = 0.005) as outcome predictors. In a subgroup analysis of 230 patients with Doppler data, predicted RV systolic pressure ≥40 mm Hg was associated with the primary outcome (HR 3.42; 95% CI 1.09 to 10.7; P = 0.04). Preoperative predictors of a composite secondary outcome-postoperative arrhythmias and heart failure-included older age at PVR, pre-PVR atrial tachyarrhythmias, and a higher left ventricular end-systolic volume index. Conclusions -In this observational investigation of patients with rTOF, an older age at PVR and pre-PVR RV hypertrophy and dysfunction were predictive of shorter time to postoperative death and sustained VT. These findings may inform the timing of PVR if confirmed by prospective clinical trials.
Date Issued
2018-10-19
Date Acceptance
2018-06-19
ISSN
0009-7322
Publisher
American Heart Association
Start Page
2106
End Page
2115
Journal / Book Title
Circulation
Volume
138
Issue
19
Copyright Statement
© 2018 American Heart Association, Inc.
Source Database
manual-entry
Sponsor
British Heart Foundation
Identifier
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.034740
Grant Number
FS/11/38/28864
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Peripheral Vascular Disease
Cardiovascular System & Cardiology
hypertrophy
right ventricular
pulmonary valve
risk factors
tachycardia
ventricular
tetralogy of Fallot
treatment outcome
ALL-CAUSE MORTALITY
LONG-TERM SURVIVAL
MAGNETIC-RESONANCE
RISK-FACTORS
ADULTS
ARRHYTHMIA
OUTCOMES
REGURGITATION
ASSOCIATION
MULTICENTER
hypertrophy, right ventricular
pulmonary valve
risk factors
tachycardia, ventricular
tetralogy of Fallot
treatment outcome
Cardiovascular System & Hematology
1103 Clinical Sciences
1102 Cardiorespiratory Medicine and Haematology
1117 Public Health and Health Services
Publication Status
Published
Date Publish Online
2018-10-19