2110Risk stratification and clinical outcomes after pulmonary valve replacement

Abstract

Background: We hypothesized that if right ventricular (RV) dilation and dysfunction was the pathophysiologic mechanism for adverse outcomes in pulmonary regurgitation, then preoperative RV volumetric and echocardiographic indices will predict cardiovascular adverse event (CAE) after pulmonary valve replacement (PVR). Methods: Retrospective of patients with native pulmonary regurgitation and preoperative cardiac magnetic resonance imaging (CMRI) who underwent replacement (PVR) at Mayo Clinic Rochester, 2000-2015. The patients were divided into quartiles based on RV end-diastolic volume index (RVEDVI). The patients in the lowest quartile (Group A, n=46) and the top quartile (Group B, n=42) were selected as the study cohort. Results: Of the 88 patients in the study, 62 (71%) had tetralogy of Fallot while 26 (29%) had valvular pulmonic stenosis. In comparison to Group A, Group B patients were older at time of PVR (28±4 vs 33±5 years, p=0.011) but otherwise there was no significant difference in baseline characteristics of both cohorts. Freedom from CAE (death, heart transplant listing, palliative care, heart failure hospitalization, stroke or sustained ventricular tachycardia) was significantly different between Groups A and B, 84 vs 53% at 60 months, p=0.002. The combination of RV end systolic volume index (RVESVI) >95 ml/m2 and Tricuspid annular plane systolic excursion/RV systolic pressure (TAPSE/RVSP) <0.4 predicted CAE with sensitivity of 67%, specificity of 92%, and AUC 0.731. Conclusion: RVESVI and TAPSE/RVSP were good predictors of CAE and perhaps will improve risk stratification. Further studies are required to assess the performance of these indices in an unselected population of patients undergoing PVR.