Abstract 9635: Percutaneous vs. Surgical Pulmonary Valve Implantation: How Does the Right Ventricle Fare?

Abstract

Introduction. Percutaneous pulmonary valve implantation (PPVI) to non-invasively correct pulmonary valve dysfunction is a recent advancement. Cardiopulmonary bypass is known to have a negative impact on right ventricular (RV) function. This study was designed to assess RV recovery using echocardiographic parameters post surgical pulmonary graft placement versus PPVI. Methods. Retrospective study of consecutive adult patients who underwent PPVI and received graft bioprosthesis between 2007 and 2011. Echocardiographic parameters analyzed included tricuspid annular systolic excursion (TAPSE), RV tissue Doppler velocity (TDV), and myocardial performance index (MPI). Graphs of relative differences (between postoperative and preoperative values) for each parameter were constructed to compare preoperative, early (≤60 days) and late postoperative (≥6-12 months) measurements. Significance of results was determined using T-test. Results. Ten patients received PPVI and 26 underwent open heart surgery with graft insertion. Average patient age was 31±20 years. Pre-operative TDV (p=0.008), and MPI (p=0.05) were significantly higher for the surgical population than the percutaneous group. Postoperative, TDV and TAPSE were significantly lower early (p<0.001) and late (p<0.001) in the surgical group than preoperative measures. No significant differences were seen for the PPVI group. On comparison of relative differences in parameters between groups TDI was significantly higher both early (p<0.001) and late (p<0.006) postoperatively in the percutaneous group. Conclusion. RV systolic recovery as measured by TDV and TAPSE was significantly impaired post surgery but relatively unchanged post PPVI. On analysis of relative differences in RV parameters, TDI was significantly higher early and late post PPVI than open-heart surgery suggesting that surgery may impact RV function more significantly than its percutaneous counterpart.