News | Congenital Heart | May 06, 2015

Age, Valve Type Key Determinants for Congenital Re-Intervention

Younger, smaller children at greater risk for complications following pulmonary valve replacement

pulmonary valve replacement, congenital, re-intervention, age, PVR

May 6, 2015 — A retrospective review of 633 adults and children who underwent bioprosthetic pulmonary valve replacement (PVR) for congenital heart disease between 1996 and 2014 indicated that the risk of re-intervention was five times greater for children than adults. In addition, the likelihood of re-intervention decreased by 10 percent for each increasing year of age at surgery. Valve type was another important determinant of re-intervention, according to Rio S. Nomoto, BA, medical student at Tufts University School of Medicine, who presented the results of this research at the 95th American Association for Thoracic Surgery (AATS) Annual Meeting in Seattle on April 28.

PVR is recommended for both asymptomatic and symptomatic patients with CHD who have increased risk for right ventricular dilation and dysfunction. These patients may exhibit exercise intolerance, arrhythmia and sudden cardiac events. Pulmonary regurgitation is a common indication for PVR.

“In this comprehensive series, we have identified specific valve type and all measures related to younger patient age at surgery to be important predictors of re-intervention,” explained lead investigator Christopher W. Baird, M.D., of the Department of Cardiac Surgery at Boston Children’s Hospital of Harvard Medical School. The researchers also found that patients who were small for their age were much more likely to experience valve failure, suggesting that these children merit more intensive long-term follow-up.

In this group of 633 patients, the median age at surgery was 17.5 years, and 49 percent of the patients were younger than 18 years. Eight patients were infants. Sixty-eight percent of cases had a diagnosis of Tetralogy of Fallot. The median follow-up was 2.9 years.

Six percent of patients (44) required re-intervention. Of these, 17 underwent a surgical re-intervention and 27 had cardiac catheterization to replace the pulmonary valve. Most events precipitating re-intervention happened at least three years after initial surgery. Thirty patients required more than one re-intervention and 19 deaths occurred post-operatively or during follow-up.

Age at surgery was an important predictor of future re-intervention. At five years post-op, the re-intervention rate was 11 percent for patients younger than 12 years, 7 percent for those 12-27 years old and 0 percent for those older than 27 years. At 10 years after surgery, 100 percent of children who had been operated on when they were less than 6 years old required repeat surgery, as did 74 percent of those who had been between 6 and 11 years old; in contrast, the re-intervention rate was 22 percent for those age 12 to 17 years and 10 percent for those between 18 and 26 years old. None of the patients who were 27 years or older at the time of surgery required re-intervention at the 10-year mark, noted Nomoto.

Other factors associated with younger age were also found to be risk factors for re-intervention, such as low body weight, small body surface area and body mass index (BMI). For instance, those younger than 20 years of age with BMI more than two standard deviations below normal were seven times more likely to experience valve failure. “Children with low BMI may merit closer monitoring following PVR or nutritional counseling to increase BMI prior to scheduling surgery,” suggested Baird.

There was also a significant difference in the risk of re-intervention according to valve type. Fifty percent of patients received the Sorin Mitroflow, 35 percent the CE Magna or MagnaEase, 11 percent the CE Perimount and 4 percent porcine values. Of the four valves evaluated, the Sorin Mitroflow exhibited a significantly higher re-intervention rate (17.6 percent) than the others.

Neither larger valve size nor BSA-adjusted valve orifice size predicted re-intervention. The investigators also found that the magnitude of the valve type differences was independent of age.

For more information: www.aats.org

Related Content

Hypertension Found in Children Exposed to Flower Pesticides
News | Congenital Heart | June 03, 2019
Researchers at University of California San Diego School of Medicine found higher blood pressure and pesticide...
Edwards Recalls Miller and Fogarty Balloon Dilation Atrioseptostomy Catheters
News | Congenital Heart | April 29, 2019
Edwards Lifesciences is recalling the Miller Balloon Atrioseptostomy Catheter and Fogarty Dilation Atrioseptostomy...
New Pediatric Blood Pressure Guidelines Improve Premature Heart Disease Identification
News | Congenital Heart | April 22, 2019
New guidelines that classified more children as having elevated blood pressure  are better at predicting which kids are...
Better Options Needed for Children at Higher Risk of Premature Heart Disease
News | Congenital Heart | February 28, 2019
Obesity and severe obesity in childhood and adolescence have been added to the list of conditions that put children and...
Climate Change May Increase Congenital Heart Defects
News | Congenital Heart | January 30, 2019
Rising temperatures stemming from global climate change may increase the number of infants born with congenital heart...
Videos | Congenital Heart | November 01, 2018
Example of GE Healthcare’s FetalHQ software for the ultrasound imaging of fetal hearts.
Cardiac Ultrasound Software Streamlines Fetal Heart Exams
Feature | Congenital Heart | October 30, 2018
A new tool called fetalHQ on GE Healthcare’s Voluson ultrasound systems is the first tool to simultaneously examine the...
St. Louis Children's and Washington University Heart Center Perform Rare Infant Heart-Lung Transplant

Image courtesy of St. Louis Children's and Washington University Heart Center

News | Congenital Heart | September 25, 2018
Five-month-old Jack Palmer is home with his family in Kansas City after undergoing an extremely rare heart-lung...
New Research Explores Role of Gene Mutation in Congenital Heart Defects
News | Congenital Heart | June 18, 2018
June 18, 2018 — Heart defects are the most common type of birth defect, and can be caused by mutations in the gene CH
Global Study Examines Therapy for Patients with Single-Ventricle Cardiac Defect

Image courtesy of Hayek Medical

News | Congenital Heart | May 02, 2018
Select adult patients born with a single functioning ventricle, and who have undergone a surgical operation called the...
Overlay Init