Abstract 3124: Impact of Age on Outcome of Pulmonary Valve Replacement for Pulmonary Regurgitation
Objectives: Pulmonary valve replacement (PVR) for pulmonary regurgitation improves right ventricular function when performed relatively early. Effects on exercise performance are still controversial. Furthermore little attention has been given to the effects on left ventricular function.
Methods: 60 patients (mean age 20.5 ± 10.4, 27 male, 77% tetralogy of Fallot) underwent pulmonary valve replacement (PVR). Indications for intervention were presence of severe PR (regurgitant fraction ≥ 35%) and RV/LV end-diastolic volume ≥1.5. Fifty-six patients had a pulmonary homograft (mean size 21.5±1.7 mm). Magnetic resonance imaging and cardiopulmonary exercise testing (CPEX) were performed prior to and 1 year after intervention. NYHA class was also recorded.
Results: On a retrospective analysis, we found that Ve/VCO2 exercise parameter was most likely to normalize when PVR was performed at a younger age (< than 16 years, p=0.027). We therefore compared the results between the younger patients (group 1: n=24, 6 male, mean age of PVR 12±2.4 years) and the older patients (group 2: n=37, 21 male, mean age of PVR 26±10 years). Before intervention there were no differences in MR parameters. NYHA class was ≤ 2 in 83% of patients in group 1 vs 51% in group 2, p=0.01. Following PVR, only group 1 had a significant improvement in RV effective strove volume (40.9±8.7 to 47.1±7.1 mL/beat, p=0.001 vs 40.3±9.9 to 43.8±10.2, ns); in both groups there was a significant increase in LV end-diastolic volume, reflecting a better filling, and LV effective stroke volume (effSV), although these changes were more pronounced in group 1 (EDV: 11±11 vs 4±12 mL, p=0.041; effSV: 26±7 vs 19±11 mL/beat, p=0.025). Ve/VCO2 improved significantly only in group 1 (33±3 to 30±4, p=0.015, vs 36±6 to 35±7, ns).
Conclusions: PVR leads to a better RV and LV performance when performed at a younger age. This is mirrored by an improved Ve/VCO2 exercise parameter which is more likely to normalize when surgery is performed prior to 16 year of age.