O-7
The Impact of Patient Prosthesis Mismatch on the Outcome of Transcatheter Pulmonary Valve Implantation
Presenter
Daiji Takajo, MD, MPH, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Daiji Takajo, MD, MPH, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, Thomas J. Forbes, M.D., Joe DiMaggio Children's Hospital, Hollywood, FL and Daisuke Kobayashi, MD, MPH, FSCAI, Washington University in St. Louis, Saint Louis, MO
Keywords: Congenital Heart Disease (CHD) and TPVR/Pulmonary Valve
Background
Patient prosthesis mismatch (PPM) is an important factor of the outcome in transcatheter aortic valve implantation. However, the impact of PPM in transcatheter pulmonary valve implantation (TPVI) has not been studied.
Methods
Based on the narrowest valve stent diameters in two views of fluoroscopy, internal geometric orifice area (GOA) of the valve stent was calculated and indexed by body surface area (BSA), deriving iGOA. To define PPM in TPVI, receiver operating characteristics (ROC) curve analysis for iGOA for predicting significant residual RVOT gradient was used to derive the optimal cut-off value of iGOA. Our cohort were divided into two groups: PPM versus non-PPM. The clinical data were compared between two groups.
Results
TPVI was performed using Melody valve in 101 patients. Significant RVOT residual pressure gradient (≥ 15 mmHg) was observed in 31 patients (39.6%). Over a mean follow up periods of 4.0 ± 3.4 years, 22 patients (21.8%) required repeat interventions (17 transcatheter, 11 surgical, and both in 6 patients). Based on the ROC analysis, the best cut-off value of iGOA was 1.25 cm
2/m
2 (area under the curve 0.873,
p < 0.001) to define PPM. PPM was present in 42 patients (42%). On the Kaplan-Meier survival analysis, PPM was associated with need of repeat intervention (p=0.02).
Conclusions
In TPVI, PPM was a strong predictor for the need of re-intervention. Considering PPM, target diameter of valve stent would depend on the patient body size and should be taken into account for optimal outcome of TPVI.