P4164Transcatheter pulmonary valve implantation versus surgical pulmonary conduit replacement in corrected tetralogy of Fallot with pulmonary atresia: a propensity matched comparison

Abstract

Abstract Background Tetralogy of Fallot with pulmonary artesia (PA-VSD) complete repair includes the placement of a right ventricle to pulmonary artery conduit. As more and more patients survive past childhood, the need for conduit replacement has increased. Transcatheter pulmonary valve implantation (TPVI) has emerged as an alternative to the surgical pulmonary valve replacement (SPVR) in conduit failure, but comparative data are lacking. Purpose We aim to use data from a national procedural audit database to compare TPVI and SPVR in operated PA-VSD with conduit failure. Method All patients with surgically corrected PA-VSD undergoing TPVI or SPVR between 2006–2012 were included (SPVR n=103, TPVI n=31). A propensity score matching algorithm based on age, gender, known genetic mutations, MAPCAs presence of endocarditis, preoperative mechanical support, operation year and follow-up time was used and resulted in balanced groups. Results Median age at TPVI and SPVR were 23 years (11–51) and 12 years (0.3–55) respectively. Median follow-up was 3.7 years (1 day-12.5 years) in SPVR and 2 years (0.3–10.6) in TPVI. There were slightly more females in the TPVI group (64% vs 49% in SPVR p=0.1). There were no significant differences in procedure era (77% after 2005), MAPCAs (31%) or known genetic conditions (17%). All cases of preoperative endocarditis (n=6) and mechanical support (n=4) were in the SPVR group. Survival, freedom from pulmonary valve replacement (PVR) and PVR free survival before and after matching at 5 years are shown in Table. After matching survival tended to be lower in TPVI (p=0.4), but without reaching statistical significance, while freedom from PVR (p=0.004, Figure) and PVR free survival (0.02) were significantly lower after TPVI, compared to SPVR. Relative mortality by age increments Before matching After matching TPVI SPVR TPVI SPVR p value Survival at 5 years (%) 87 92 87 94 0.4 Freedom from PVR at 5 years (%) 83 96 83 100 0.004 PVR free survival at 5 years (%) 72 88 72 94 0.02 Conclusions In our study TPVI showed comparable midterm survivable with SPVR, but significantly lower freedom from PVR, resulting in a lower PVR free survival. Further studies with longer follow-up and a prospective design are needed to investigate the factors influencing these outcomes.