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Preoperative Predictors of Death and Sustained Ventricular Tachycardia After Pulmonary Valve Replacement in Patients With Repaired Tetralogy of Fallot Enrolled in the INDICATOR Cohort

Circulation (New York, N.Y.), 2018-11, Vol.138 (19), p.2106-2115 [Peer Reviewed Journal]

2018 by the American College of Cardiology Foundation and the American Heart Association, Inc. ;ISSN: 0009-7322 ;EISSN: 1524-4539 ;DOI: 10.1161/CIRCULATIONAHA.118.034740 ;PMID: 30030416

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Title:
Preoperative Predictors of Death and Sustained Ventricular Tachycardia After Pulmonary Valve Replacement in Patients With Repaired Tetralogy of Fallot Enrolled in the INDICATOR Cohort
Author: Geva, Tal ; Mulder, Barbara ; Gauvreau, Kimberlee ; Babu-Narayan, Sonya V ; Wald, Rachel M ; Hickey, Kelsey ; Powell, Andrew J ; Gatzoulis, Michael A ; Valente, Anne Marie
Subjects: Adolescent ; Adult ; Cardiac Surgical Procedures - adverse effects ; Cardiac Surgical Procedures - mortality ; Echocardiography, Doppler ; Electrocardiography ; Female ; Heart Valve Prosthesis Implantation - adverse effects ; Heart Valve Prosthesis Implantation - mortality ; Hemodynamics ; Humans ; Hypertrophy, Right Ventricular - etiology ; Hypertrophy, Right Ventricular - mortality ; Hypertrophy, Right Ventricular - physiopathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pulmonary Valve - diagnostic imaging ; Pulmonary Valve - physiopathology ; Pulmonary Valve - surgery ; Pulmonary Valve Stenosis - etiology ; Pulmonary Valve Stenosis - mortality ; Pulmonary Valve Stenosis - physiopathology ; Pulmonary Valve Stenosis - surgery ; Registries ; Risk Assessment ; Risk Factors ; Tachycardia, Ventricular - diagnosis ; Tachycardia, Ventricular - etiology ; Tachycardia, Ventricular - mortality ; Tachycardia, Ventricular - physiopathology ; Tetralogy of Fallot - mortality ; Tetralogy of Fallot - physiopathology ; Tetralogy of Fallot - surgery ; Time Factors ; Treatment Outcome ; Ventricular Dysfunction, Right - etiology ; Ventricular Dysfunction, Right - mortality ; Ventricular Dysfunction, Right - physiopathology ; Ventricular Function, Right ; Young Adult
Is Part Of: Circulation (New York, N.Y.), 2018-11, Vol.138 (19), p.2106-2115
Description: BACKGROUND:Risk factors for adverse clinical outcomes have been identified in patients with repaired tetralogy of Fallot before pulmonary valve replacement (PVR). However, pre-PVR predictors for post-PVR sustained ventricular tachycardia and death have not been identified. METHODS:Patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort (International Multicenter TOF Registry), a 4-center international cohort study, who had a comprehensive preoperative evaluation and subsequently underwent PVR were included. Preprocedural clinical, ECG, cardiovascular magnetic resonance, and postoperative outcome data were analyzed. Cox proportional hazards multivariable regression analysis was used to evaluate factors associated with time from pre-PVR cardiovascular magnetic resonance until the primary outcomedeath, aborted sudden cardiac death, or sustained ventricular tachycardia. RESULTS:Of the 452 eligible patients (median age at PVR, 25.8 years), 36 (8%) reached the primary outcome (27 deaths, 2 resuscitated death, and 7 sustained ventricular tachycardia) at a median time after PVR of 6.5 years. Cox proportional hazards regression identified pre-PVR right ventricular ejection fraction <40% (hazard ratio, 2.39; 95% CI, 1.18–4.85; P=0.02), right ventricular mass-to-volume ratio ≥0.45 g/mL (hazard ratio, 4.08; 95% CI, 1.57–10.6; P=0.004), and age at PVR ≥28 years (hazard ratio, 3.10; 95% CI, 1.42–6.78; P=0.005) as outcome predictors. In a subgroup analysis of 230 patients with Doppler data, predicted right ventricular systolic pressure ≥40 mm Hg was associated with the primary outcome (hazard ratio, 3.42; 95% CI, 1.09–10.7; P=0.04). Preoperative predictors of a composite secondary outcome, postoperative arrhythmias and heart failure, included older age at PVR, pre-PVR atrial tachyarrhythmias, and a higher left ventricular end-systolic volume index. CONCLUSIONS:In this observational investigation of patients with repaired tetralogy of Fallot, an older age at PVR and pre-PVR right ventricular hypertrophy and dysfunction were predictive of a shorter time to postoperative death and sustained ventricular tachycardia. These findings may inform the timing of PVR if confirmed by prospective clinical trials.
Publisher: United States: by the American College of Cardiology Foundation and the American Heart Association, Inc
Language: English
Identifier: ISSN: 0009-7322
EISSN: 1524-4539
DOI: 10.1161/CIRCULATIONAHA.118.034740
PMID: 30030416
Source: GFMER Free Medical Journals
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Preoperative Predictors of Death and Sustained Ventricular Tachycardia After Pulmonary Valve Replacement in Patients With Repaired Tetralogy of Fallot Enrolled in the INDICATOR Cohort

2018 by the American College of Cardiology Foundation and the American Heart Association, Inc. ;ISSN: 0009-7322 ;EISSN: 1524-4539 ;DOI: 10.1161/CIRCULATIONAHA.118.034740 ;PMID: 30030416

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