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Heart. 2018 Nov;104(21):1791-1796. doi: 10.1136/heartjnl-2017-312769. Epub 2018 Apr 10.

Ventricular arrhythmia burden after transcatheter versus surgical pulmonary valve replacement.

Author information

Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA.
Division of Cardiac Electrophysiology, UCLA Cardiac Arrhythmia Center, Los Angeles, California, USA.
Division of Cardiothoracic Surgery, UCLA Mattel Children's Hospital, Los Angeles, California, USA.
Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California, USA.
Division of Pediatric Cardiology, Kaiser Permanente, Los Angeles, California, USA.



Comparative ventricular arrhythmia (VA) outcomes following transcatheter (TC-PVR) or surgical pulmonary valve replacement (S-PVR) have not been evaluated. We sought to compare differences in VAs among patients with congenital heart disease (CHD) following TC-PVR or S-PVR.


Patients with repaired CHD who underwent TC-PVR or S-PVR at the UCLA Medical Center from 2010 to 2016 were analysed retrospectively. Patients who underwent hybrid TC-PVR or had a diagnosis of congenitally corrected transposition of the great arteries were excluded. Patients were screened for a composite of non-intraoperative VA (the primary outcome variable), defined as symptomatic/recurrent non-sustained ventricular tachycardia (VT) requiring therapy, sustained VT or ventricular fibrillation. VA epochs were classified as 0-1 month (short-term), 1-12 months (mid-term) and ≥1 year (late-term).


Three hundred and two patients (TC-PVR, n=172 and S-PVR, n=130) were included. TC-PVR relative to S-PVR was associated with fewer clinically significant VAs in the first 30 days after valve implant (adjusted HR 0.20, p=0.002), but similar mid-term and late-term risks (adjusted HR 0.72, p=0.62 and adjusted HR 0.47, p=0.26, respectively). In propensity-adjusted models, S-PVR, patient age at PVR and native right ventricular outflow tract (RVOT) (vs bioprosthetic/conduit outflow tract) were independent predictors of early VA after pulmonary valve implantation (p<0.05 for all).


Compared with S-PVR, TC-PVR was associated with reduced short-term but comparable mid-term and late-term VA burdens. Risk factors for VA after PVR included a surgical approach, valve implantation into a native RVOT and older age at PVR.


congenital heart disease surgery; pulmonic valve disease; transcatheter valve interventions; ventricular tachycardia

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