Imperial College London
Alternate

DrSonyaBabu-Narayan

Faculty of Medicine, National Heart & Lung Institute

Reader in Adult Congenital Heart Disease
 
 
 
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Contact

 

+44 (0)20 7351 8803s.babu-narayan

 
 
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Location

 

NIHR Cardiovascular Biomedical RChelsea WingRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@inproceedings{Bokma:2018,
author = {Bokma, JP and Mulder, BJ and Hickey, K and Babu-Narayan, SV and Wald, RM and Gatzoulis, MA and Sleeper, LA and Geva, T and Valente, AM},
publisher = {LIPPINCOTT WILLIAMS & WILKINS},
title = {Prognostic Effects of Pulmonary Valve Replacement in Repaired Tetralogy of Fallot: Results From a Large Multicenter Study},
url = {http://hdl.handle.net/10044/1/63769},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - CPAPER
AB  - Introduction: The prognostic impact and optimal timing of pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (rTOF) remains a subject of debate. The objective of this study was to determine whether PVR was associated with beneficial outcome.Methods: In this multicenter, case-controlled study, clinical, ECG, cardiac magnetic resonance (CMR) and outcome data of rTOF patients were collected. A propensity score for PVR was created to adjust for baseline differences between PVR and non-PVR patients. A frailty failure time model was used to determine the association of PVR, with matching on propensity score and adjustment for other risk factors, on time to the composite of death/sustained ventricular tachycardia (VT). In addition, differential association between impact of PVR and outcome according to predefined ‘proactive’ and ‘conservative’ (see figure) criteria was studied.Results: A total of 440 PVR patients (age 24±13 years at baseline CMR, 58% male, RV ejection fraction (EF) 47±8%, QRS duration 148±27ms) and 537 non-PVR patients (age 29±15 years, 53% male, RV EF 51±8%, QRS duration 140±27ms) were included. During follow-up of 5.3±3.1 years, 41 events occurred (30 death, 11 sustained VT). The adjusted hazard ratio (HR) for death/sustained VT for patients with versus without PVR was 0.65 (95% CI: 0.31, 1.36, p=0.25). There was an increasing hazard of event across prespecified ordered PVR x criteria subgroups (Figure; P=0.044 for proactive, P=0.002 for conservative). There was a two-fold risk (hazard ratio=2.15, 95% CI: 1.34, 3.46) comparing each adjacent subgroup, suggesting benefit of PVR when conservative criteria were met, and lack of benefit of PVR when criteria were not met. A roughly similar pattern was seen according to proactive criteria.Conclusions: In this multicenter, 5-year follow-up study in patients with rTOF, conservative guidelines seemed useful in selecting patient
AU  - Bokma,JP
AU  - Mulder,BJ
AU  - Hickey,K
AU  - Babu-Narayan,SV
AU  - Wald,RM
AU  - Gatzoulis,MA
AU  - Sleeper,LA
AU  - Geva,T
AU  - Valente,AM
PB  - LIPPINCOTT WILLIAMS & WILKINS
PY  - 2018///
SN  - 0009-7322
TI  - Prognostic Effects of Pulmonary Valve Replacement in Repaired Tetralogy of Fallot: Results From a Large Multicenter Study
UR  - http://hdl.handle.net/10044/1/63769
ER  -
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