Association between patient age at implant and outcomes after transcatheter pulmonary valve replacement in the multicenter Melody valve trials

Aimee K. Armstrong, Felix Berger, Thomas K. Jones, John W. Moore, Lee N. Benson, John P. Cheatham, Daniel R. Turner, John F. Rhodes, Julie A. Vincent, Thomas M Zellers, Te Hsin Lung, Andreas Eicken, Doff B. McElhinney

Research output: Contribution to journalArticle

Abstract

Objectives: To investigate whether age and valve size at implant contribute to outcomes after Melody transcatheter pulmonary valve replacement (TPVR). Background: Patient age and valve size at implant contribute to longevity of surgical pulmonary valves. Methods: All patients discharged with a Melody valve in the pulmonary position, as part of three prospective Melody valve multicenter studies, comprised the study cohort. Acute and time-related outcomes were analyzed according to age: children (≤12 years), adolescents (13–18 years), young adults (19–29 years), and older adults (≥30 years). Results: Successful Melody valve implantation occurred in 49 children, 107 adolescents, 96 young adults, and 57 older adults. Pediatric patients (≤18 years) were more likely to have TPVR for conduit stenosis than adults (62% vs. 44%); children had the smallest conduits. After TPVR, pediatric and adult patients had similar decreases in right ventricular (RV) size by MRI, but adults had improved percentage predicted peak VO2 (58% preimplant to 64% postimplant, p =.02) and FEV1 (69% pre to 71% post, p =.005). Younger age was associated with shorter freedom from RVOT dysfunction, reintervention, and explant. Children had the shortest freedom from endocarditis (p =.041), but all other groups had 5-year freedom from endocarditis of ≥90%. Conclusions: Younger age was associated with shorter time to RVOT dysfunction, reintervention, and explant after Melody TPVR. Patients ≥13 years of age were at low risk for endocarditis and explant to 5 years. A better understanding of time-related outcomes by age will aid in the comparison of therapeutic options for TPVR candidates. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT00740870 (NCT00740870), https://clinicaltrials.gov/ct2/show/NCT01186692 (NCT01186692), and https://clinicaltrials.gov/ct2/show/NCT00688571 (NCT00688571).

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - Jan 1 2019

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Pulmonary Valve
Endocarditis
Young Adult
Pediatrics
Surgical Instruments
Multicenter Studies
Pathologic Constriction
Cohort Studies
Clinical Trials

Keywords

  • tetralogy of Fallot
  • TPVR

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Association between patient age at implant and outcomes after transcatheter pulmonary valve replacement in the multicenter Melody valve trials. / Armstrong, Aimee K.; Berger, Felix; Jones, Thomas K.; Moore, John W.; Benson, Lee N.; Cheatham, John P.; Turner, Daniel R.; Rhodes, John F.; Vincent, Julie A.; Zellers, Thomas M; Lung, Te Hsin; Eicken, Andreas; McElhinney, Doff B.

In: Catheterization and Cardiovascular Interventions, 01.01.2019.

Research output: Contribution to journalArticle

Armstrong, AK, Berger, F, Jones, TK, Moore, JW, Benson, LN, Cheatham, JP, Turner, DR, Rhodes, JF, Vincent, JA, Zellers, TM, Lung, TH, Eicken, A & McElhinney, DB 2019, 'Association between patient age at implant and outcomes after transcatheter pulmonary valve replacement in the multicenter Melody valve trials', Catheterization and Cardiovascular Interventions. https://doi.org/10.1002/ccd.28454
Armstrong, Aimee K. ; Berger, Felix ; Jones, Thomas K. ; Moore, John W. ; Benson, Lee N. ; Cheatham, John P. ; Turner, Daniel R. ; Rhodes, John F. ; Vincent, Julie A. ; Zellers, Thomas M ; Lung, Te Hsin ; Eicken, Andreas ; McElhinney, Doff B. / Association between patient age at implant and outcomes after transcatheter pulmonary valve replacement in the multicenter Melody valve trials. In: Catheterization and Cardiovascular Interventions. 2019.
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abstract = "Objectives: To investigate whether age and valve size at implant contribute to outcomes after Melody transcatheter pulmonary valve replacement (TPVR). Background: Patient age and valve size at implant contribute to longevity of surgical pulmonary valves. Methods: All patients discharged with a Melody valve in the pulmonary position, as part of three prospective Melody valve multicenter studies, comprised the study cohort. Acute and time-related outcomes were analyzed according to age: children (≤12 years), adolescents (13–18 years), young adults (19–29 years), and older adults (≥30 years). Results: Successful Melody valve implantation occurred in 49 children, 107 adolescents, 96 young adults, and 57 older adults. Pediatric patients (≤18 years) were more likely to have TPVR for conduit stenosis than adults (62{\%} vs. 44{\%}); children had the smallest conduits. After TPVR, pediatric and adult patients had similar decreases in right ventricular (RV) size by MRI, but adults had improved percentage predicted peak VO2 (58{\%} preimplant to 64{\%} postimplant, p =.02) and FEV1 (69{\%} pre to 71{\%} post, p =.005). Younger age was associated with shorter freedom from RVOT dysfunction, reintervention, and explant. Children had the shortest freedom from endocarditis (p =.041), but all other groups had 5-year freedom from endocarditis of ≥90{\%}. Conclusions: Younger age was associated with shorter time to RVOT dysfunction, reintervention, and explant after Melody TPVR. Patients ≥13 years of age were at low risk for endocarditis and explant to 5 years. A better understanding of time-related outcomes by age will aid in the comparison of therapeutic options for TPVR candidates. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT00740870 (NCT00740870), https://clinicaltrials.gov/ct2/show/NCT01186692 (NCT01186692), and https://clinicaltrials.gov/ct2/show/NCT00688571 (NCT00688571).",
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AU - Armstrong, Aimee K.

AU - Berger, Felix

AU - Jones, Thomas K.

AU - Moore, John W.

AU - Benson, Lee N.

AU - Cheatham, John P.

AU - Turner, Daniel R.

AU - Rhodes, John F.

AU - Vincent, Julie A.

AU - Zellers, Thomas M

AU - Lung, Te Hsin

AU - Eicken, Andreas

AU - McElhinney, Doff B.

PY - 2019/1/1

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N2 - Objectives: To investigate whether age and valve size at implant contribute to outcomes after Melody transcatheter pulmonary valve replacement (TPVR). Background: Patient age and valve size at implant contribute to longevity of surgical pulmonary valves. Methods: All patients discharged with a Melody valve in the pulmonary position, as part of three prospective Melody valve multicenter studies, comprised the study cohort. Acute and time-related outcomes were analyzed according to age: children (≤12 years), adolescents (13–18 years), young adults (19–29 years), and older adults (≥30 years). Results: Successful Melody valve implantation occurred in 49 children, 107 adolescents, 96 young adults, and 57 older adults. Pediatric patients (≤18 years) were more likely to have TPVR for conduit stenosis than adults (62% vs. 44%); children had the smallest conduits. After TPVR, pediatric and adult patients had similar decreases in right ventricular (RV) size by MRI, but adults had improved percentage predicted peak VO2 (58% preimplant to 64% postimplant, p =.02) and FEV1 (69% pre to 71% post, p =.005). Younger age was associated with shorter freedom from RVOT dysfunction, reintervention, and explant. Children had the shortest freedom from endocarditis (p =.041), but all other groups had 5-year freedom from endocarditis of ≥90%. Conclusions: Younger age was associated with shorter time to RVOT dysfunction, reintervention, and explant after Melody TPVR. Patients ≥13 years of age were at low risk for endocarditis and explant to 5 years. A better understanding of time-related outcomes by age will aid in the comparison of therapeutic options for TPVR candidates. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT00740870 (NCT00740870), https://clinicaltrials.gov/ct2/show/NCT01186692 (NCT01186692), and https://clinicaltrials.gov/ct2/show/NCT00688571 (NCT00688571).

AB - Objectives: To investigate whether age and valve size at implant contribute to outcomes after Melody transcatheter pulmonary valve replacement (TPVR). Background: Patient age and valve size at implant contribute to longevity of surgical pulmonary valves. Methods: All patients discharged with a Melody valve in the pulmonary position, as part of three prospective Melody valve multicenter studies, comprised the study cohort. Acute and time-related outcomes were analyzed according to age: children (≤12 years), adolescents (13–18 years), young adults (19–29 years), and older adults (≥30 years). Results: Successful Melody valve implantation occurred in 49 children, 107 adolescents, 96 young adults, and 57 older adults. Pediatric patients (≤18 years) were more likely to have TPVR for conduit stenosis than adults (62% vs. 44%); children had the smallest conduits. After TPVR, pediatric and adult patients had similar decreases in right ventricular (RV) size by MRI, but adults had improved percentage predicted peak VO2 (58% preimplant to 64% postimplant, p =.02) and FEV1 (69% pre to 71% post, p =.005). Younger age was associated with shorter freedom from RVOT dysfunction, reintervention, and explant. Children had the shortest freedom from endocarditis (p =.041), but all other groups had 5-year freedom from endocarditis of ≥90%. Conclusions: Younger age was associated with shorter time to RVOT dysfunction, reintervention, and explant after Melody TPVR. Patients ≥13 years of age were at low risk for endocarditis and explant to 5 years. A better understanding of time-related outcomes by age will aid in the comparison of therapeutic options for TPVR candidates. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT00740870 (NCT00740870), https://clinicaltrials.gov/ct2/show/NCT01186692 (NCT01186692), and https://clinicaltrials.gov/ct2/show/NCT00688571 (NCT00688571).

KW - tetralogy of Fallot

KW - TPVR

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