Cargando…

Association of Pulmonary Valve Morphology Differences With Outcomes in Tetralogy of Fallot Repair With Right Ventricular Outflow Tract Incision

Background: Current observational studies may not have large samples to investigate the relationship between pulmonary valve (PV) morphology differences and outcomes after complete repair for tetralogy of Fallot (TOF) by right ventricular outflow tract (RVOT) incision. This study aimed to assess the...

Descripción completa

Detalles Bibliográficos
Autores principales: Liu, Jinyang, Jiang, Xianchao, Peng, Bo, Li, Shoujun, Yan, Jun, Wang, Qiang, Liu, Zhimin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8372408/
https://www.ncbi.nlm.nih.gov/pubmed/34422925
http://dx.doi.org/10.3389/fcvm.2021.695876
_version_ 1783739787235033088
author Liu, Jinyang
Jiang, Xianchao
Peng, Bo
Li, Shoujun
Yan, Jun
Wang, Qiang
Liu, Zhimin
author_facet Liu, Jinyang
Jiang, Xianchao
Peng, Bo
Li, Shoujun
Yan, Jun
Wang, Qiang
Liu, Zhimin
author_sort Liu, Jinyang
collection PubMed
description Background: Current observational studies may not have large samples to investigate the relationship between pulmonary valve (PV) morphology differences and outcomes after complete repair for tetralogy of Fallot (TOF) by right ventricular outflow tract (RVOT) incision. This study aimed to assess the impact of PV morphology differences on outcomes after complete repair for TOF. Methods: This is a retrospective cohort study. Consecutive patients who underwent TOF repair with RVOT incision at Fuwai Hospital from January 2012 to December 2017 were included and compared according to PV morphology differences (unicuspid or bicuspid was abnormal morphology, while the tricuspid valve was normal morphology). The primary outcome was defined as a composite of death, or reintervention, or significant annular peak gradient (APG), or significant pulmonary regurgitation (PR), whichever occurred first. Multivariable Cox model analysis was used to assess the relationships between PV morphology differences and outcomes. Subgroup analysis and Propensity-score analysis were performed as sensitivity analyses to assess the robustness of our results. Results: The cohort included a total of 1,861 patients with primary diagnosis of TOF, with 1,688 undergoing CR-TOF with RVOT incision. The median age was 318 days [interquartile range (IQR): 223–534 days], a median weight of 8.9 kg (IQR: 7.6–10.5 kg) and 60.0% (1,011) were male. Complete follow-up data were available for 1,673 CR-TOF patients with a median follow-up duration of 49 months. Adjusted risks for the primary outcome and significant APG were lower for patients with normal PV morphology at follow up [adjusted hazard ratio (HR): 0.68; 95% CI: 0.46–0.98; adjusted HR: 0.22; 95% CI: 0.07–0.71, respectively]. The trend for the primary outcome during follow-up remained unchanged, even in subgroups and propensity score matching analyses. Conclusions: In this analysis of data from a large TOF cohort, patients with normal tricuspid PVs were associated with a decreased risk of the primary outcome and a lower risk of significant APG, as compared with patients with abnormal unicuspid or bicuspid PVs.
format Online
Article
Text
id pubmed-8372408
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-83724082021-08-19 Association of Pulmonary Valve Morphology Differences With Outcomes in Tetralogy of Fallot Repair With Right Ventricular Outflow Tract Incision Liu, Jinyang Jiang, Xianchao Peng, Bo Li, Shoujun Yan, Jun Wang, Qiang Liu, Zhimin Front Cardiovasc Med Cardiovascular Medicine Background: Current observational studies may not have large samples to investigate the relationship between pulmonary valve (PV) morphology differences and outcomes after complete repair for tetralogy of Fallot (TOF) by right ventricular outflow tract (RVOT) incision. This study aimed to assess the impact of PV morphology differences on outcomes after complete repair for TOF. Methods: This is a retrospective cohort study. Consecutive patients who underwent TOF repair with RVOT incision at Fuwai Hospital from January 2012 to December 2017 were included and compared according to PV morphology differences (unicuspid or bicuspid was abnormal morphology, while the tricuspid valve was normal morphology). The primary outcome was defined as a composite of death, or reintervention, or significant annular peak gradient (APG), or significant pulmonary regurgitation (PR), whichever occurred first. Multivariable Cox model analysis was used to assess the relationships between PV morphology differences and outcomes. Subgroup analysis and Propensity-score analysis were performed as sensitivity analyses to assess the robustness of our results. Results: The cohort included a total of 1,861 patients with primary diagnosis of TOF, with 1,688 undergoing CR-TOF with RVOT incision. The median age was 318 days [interquartile range (IQR): 223–534 days], a median weight of 8.9 kg (IQR: 7.6–10.5 kg) and 60.0% (1,011) were male. Complete follow-up data were available for 1,673 CR-TOF patients with a median follow-up duration of 49 months. Adjusted risks for the primary outcome and significant APG were lower for patients with normal PV morphology at follow up [adjusted hazard ratio (HR): 0.68; 95% CI: 0.46–0.98; adjusted HR: 0.22; 95% CI: 0.07–0.71, respectively]. The trend for the primary outcome during follow-up remained unchanged, even in subgroups and propensity score matching analyses. Conclusions: In this analysis of data from a large TOF cohort, patients with normal tricuspid PVs were associated with a decreased risk of the primary outcome and a lower risk of significant APG, as compared with patients with abnormal unicuspid or bicuspid PVs. Frontiers Media S.A. 2021-08-04 /pmc/articles/PMC8372408/ /pubmed/34422925 http://dx.doi.org/10.3389/fcvm.2021.695876 Text en Copyright © 2021 Liu, Jiang, Peng, Li, Yan, Wang and Liu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Liu, Jinyang
Jiang, Xianchao
Peng, Bo
Li, Shoujun
Yan, Jun
Wang, Qiang
Liu, Zhimin
Association of Pulmonary Valve Morphology Differences With Outcomes in Tetralogy of Fallot Repair With Right Ventricular Outflow Tract Incision
title Association of Pulmonary Valve Morphology Differences With Outcomes in Tetralogy of Fallot Repair With Right Ventricular Outflow Tract Incision
title_full Association of Pulmonary Valve Morphology Differences With Outcomes in Tetralogy of Fallot Repair With Right Ventricular Outflow Tract Incision
title_fullStr Association of Pulmonary Valve Morphology Differences With Outcomes in Tetralogy of Fallot Repair With Right Ventricular Outflow Tract Incision
title_full_unstemmed Association of Pulmonary Valve Morphology Differences With Outcomes in Tetralogy of Fallot Repair With Right Ventricular Outflow Tract Incision
title_short Association of Pulmonary Valve Morphology Differences With Outcomes in Tetralogy of Fallot Repair With Right Ventricular Outflow Tract Incision
title_sort association of pulmonary valve morphology differences with outcomes in tetralogy of fallot repair with right ventricular outflow tract incision
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8372408/
https://www.ncbi.nlm.nih.gov/pubmed/34422925
http://dx.doi.org/10.3389/fcvm.2021.695876
work_keys_str_mv AT liujinyang associationofpulmonaryvalvemorphologydifferenceswithoutcomesintetralogyoffallotrepairwithrightventricularoutflowtractincision
AT jiangxianchao associationofpulmonaryvalvemorphologydifferenceswithoutcomesintetralogyoffallotrepairwithrightventricularoutflowtractincision
AT pengbo associationofpulmonaryvalvemorphologydifferenceswithoutcomesintetralogyoffallotrepairwithrightventricularoutflowtractincision
AT lishoujun associationofpulmonaryvalvemorphologydifferenceswithoutcomesintetralogyoffallotrepairwithrightventricularoutflowtractincision
AT yanjun associationofpulmonaryvalvemorphologydifferenceswithoutcomesintetralogyoffallotrepairwithrightventricularoutflowtractincision
AT wangqiang associationofpulmonaryvalvemorphologydifferenceswithoutcomesintetralogyoffallotrepairwithrightventricularoutflowtractincision
AT liuzhimin associationofpulmonaryvalvemorphologydifferenceswithoutcomesintetralogyoffallotrepairwithrightventricularoutflowtractincision