Comparing the Long-Term Outcome of Right Ventricle to Pulmonary Artery Conduit Insertion Using the Medtronic Freestyle Porcine Valve Versus Pulmonary Allograft Valve in Adult Patients With Congenital Heart Disease

2019 ◽  
Vol 28 ◽  
pp. S77
Author(s):  
A. Thuraisingam ◽  
P. Skillington ◽  
M. Larobina ◽  
P. Wijayarathne
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Congenital Heart ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Valve Versus ◽  
Artery Conduit

scholarly journals Contemporary Patients With Congenital Heart Disease: Uniform Atrial Tachycardia Substrates Allow for Clear Ablation End Points With Improved Long-Term Outcome

2021 ◽  
Author(s):  
Charlotte Brouwer ◽  
Joachim Hebe ◽  
Peter Lukac ◽  
Jan-Hendrik Nürnberg ◽  
Jens Cosedis Nielsen ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Atrial Tachycardia ◽  
Congenital Heart ◽  
Reentrant Tachycardia ◽  
Term Outcome ◽  
End Points ◽  
Long Term Outcome ◽  
Procedural Success

Background: Poor outcome after atrial tachycardia (AT) radiofrequency catheter ablation (RFCA) in repaired congenital heart disease (CHD) has been attributed to CHD complexity. This may not apply to contemporary patients. The objective of our study was to assess outcome after RFCA for AT in contemporary patients with CHD according to prior atrial surgery and predefined procedural end points. Methods: Patients with CHD referred for AT RFCA to 3 European centers were classified as no atrial surgery/cannulation only, limited or extensive prior atrial surgery. Procedural success was predefined as termination and nonreinducibility for focal AT and bidirectional block across ablation lines for intra-atrial reentrant tachycardia and after empirical substrate ablation for noninducible patients. Patients were followed for AT recurrence and mortality. Results: Ablation was performed in 290 patients (41±17 years, 59% male; 3-dimensional mapping 89%, irrigated tip catheters 90%, transbaffle access 15%). In 197, 233 AT were targeted (196 intra-atrial reentrant tachycardia [64% cavotricuspid (mitral) isthmus–dependent, 33% systemic-venous incision–dependent] and 37 focal AT). In 93 noninducible patients, empirical substrate ablation was performed. Procedural success was achieved in 209 (84%) patients. AT recurred in 148 (54%) 10 (interquartile range, 0–25) months after RFCA. AT-free survival was significantly better in patients with no atrial repair/cannulation only and in patients with complete procedural success independently of CHD complexity. From 94 patients undergoing reablation, the initially targeted substrate had recovered in 64%. Conclusions: In contemporary patients with CHD, outcome after AT ablation is associated with presence of prior atrial surgery and achievement of predefined procedural end points rather than CHD complexity. Techniques to improve lesion durability are likely to further improve long-term outcome.

Long-term outcomes of right ventricle-to-pulmonary artery conduit insertion in adults with congenital heart disease: survival analysis by National Death Index

2021 ◽  
Author(s):  
Amalan Thuraisingam ◽  
Peter Skillington ◽  
Prakash Ludhani ◽  
Pasangi Madhuka Wijayarathne ◽  
Samuel Menahem ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Congenital Heart ◽  
Survival Function ◽  
Interquartile Range ◽  
National Death Index ◽  
Long Term Outcomes

Abstract OBJECTIVES The aim of this study was to investigate the long-term outcomes following right ventricle-to-pulmonary artery (RV-to-PA) conduit insertion of Medtronic Freestyle® porcine valve (MFV) or pulmonary allograft valve (PAV) in adult patients with congenital heart disease. METHODS Retrospective medical record review of consecutive RV-to-PA conduit insertion, using either PAV or MFV from 1991 to 2017. Perioperative data and clinic reports were collected. Cause and date of death were obtained from the Australian National Death Index to obtain survival function. RESULTS In total, 232 patients (median age 31.5 years, interquartile range 25–41 years) underwent RV-to-PA conduit insertion (PAV = 84 and MFV = 148) and were eligible for inclusion [63.8% tetralogy of Fallot (TOF); 11.6% congenital pulmonary stenosis (PS); 24.6% other diagnoses]. The overall median follow-up time was 9.1 years (interquartile range 5.3–12.6 years). The mean gradient was 11.8 ± 7.1 mmHg in PAV and 16.6 ± 9.6 mmHg in MFV patients. Congenital PS patients had 100% survival at 20 years, TOF patients at 5, 10, 15 and 20 years had 99%, 97%, 96% and 96% survival, respectively. Patients with other primary diagnoses at 5, 10, 15 and 20 years had 93%, 91%, 87% and 87% respectively. Freedom from reintervention did not differ significantly at 5 and 10 years between pulmonary allograft (98.6%, 98.6%) and Freestyle® porcine bioprosthesis (97.5%, 93%). CONCLUSIONS Both valves perform equally well with regard to patients’ freedom from reoperation, although transvalvular gradient was higher for Freestyle® patients. Congenital PS and TOF patients had better survival than patients with other primary diagnoses.

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