TY - JOUR
T1 - Adherence to clinical practice guidelines for pulmonary valve intervention after tetralogy of Fallot repair
T2 - A nationwide cohort study
AU - Massarella, Danielle
AU - McCrindle, Brian W.
AU - Runeckles, Kyle
AU - Fan, Steve
AU - Dahdah, Nagib
AU - Dallaire, Frédéric
AU - Drolet, Christian
AU - Grewal, Jasmine
AU - Hancock-Friesen, Camille L.
AU - Hickey, Edward
AU - Karur, Gauri Rani
AU - Khairy, Paul
AU - Leonardi, Benedetta
AU - Keir, Michelle
AU - Nadeem, Syed Najaf
AU - Ng, Ming Yen
AU - Shah, Ashish
AU - Tham, Edythe B.
AU - Therrien, Judith
AU - Warren, Andrew E.
AU - Vonder Muhll, Isabelle F.
AU - Van de Bruane, Alexander
AU - Yamamura, Kenichiro
AU - Farkouh, Michael
AU - Wald, Rachel M.
N1 - Publisher Copyright:
© 2023 The Author(s)
PY - 2024/2
Y1 - 2024/2
N2 - Objectives: To determine guideline adherence pertaining to pulmonary valve replacement (PVR) referral after tetralogy of Fallot (TOF) repair. Methods: Children and adults with cardiovascular magnetic resonance imaging scans and at least moderate pulmonary regurgitation were prospectively enrolled in the Comprehensive Outcomes Registry Late After TOF Repair (CORRELATE). Individuals with previous PVR were excluded. Patients were classified according to presence (+) versus absence (−) of PVR and presence (+) versus absence (−) of contemporaneous guideline satisfaction. A validated score (specific activity scale [SAS]) classified adult symptom status. Results: In total, 498 participants (57% male, mean age 32 ± 14 years) were enrolled from 14 Canadian centers (2013-2020). Mean follow-up was 3.8 ± 1.8 years. Guideline criteria for PVR were satisfied for the majority (n = 422/498, 85%), although referral for PVR occurred only in a minority (n = 167/498, 34%). At PVR referral, most were asymptomatic (75% in SAS class 1). One participant (0.6%) received PVR without meeting criteria (PVR+/indication–). The remainder (n = 75/498, 15%) did not meet criteria for and did not receive PVR (PVR–/indication–). Abnormal cardiovascular imaging was the most commonly cited indication for PVR (n = 61/123, 50%). The SAS class and ratio of right to left end-diastolic volumes were independent predictors of PVR in a multivariable analysis (hazard ratio, 3.33; 95% confidence interval, 1.92-5.8, P < .0001; hazard ratio, 2.78; 95% confidence interval, 2.18-3.55, P < .0001). Conclusions: Although a majority of patients met guideline criteria for PVR, only a minority were referred for intervention. Abnormal cardiovascular imaging was the most common indication for referral. Further research will be necessary to establish the longer-term clinical impact of varying PVR referral strategies.
AB - Objectives: To determine guideline adherence pertaining to pulmonary valve replacement (PVR) referral after tetralogy of Fallot (TOF) repair. Methods: Children and adults with cardiovascular magnetic resonance imaging scans and at least moderate pulmonary regurgitation were prospectively enrolled in the Comprehensive Outcomes Registry Late After TOF Repair (CORRELATE). Individuals with previous PVR were excluded. Patients were classified according to presence (+) versus absence (−) of PVR and presence (+) versus absence (−) of contemporaneous guideline satisfaction. A validated score (specific activity scale [SAS]) classified adult symptom status. Results: In total, 498 participants (57% male, mean age 32 ± 14 years) were enrolled from 14 Canadian centers (2013-2020). Mean follow-up was 3.8 ± 1.8 years. Guideline criteria for PVR were satisfied for the majority (n = 422/498, 85%), although referral for PVR occurred only in a minority (n = 167/498, 34%). At PVR referral, most were asymptomatic (75% in SAS class 1). One participant (0.6%) received PVR without meeting criteria (PVR+/indication–). The remainder (n = 75/498, 15%) did not meet criteria for and did not receive PVR (PVR–/indication–). Abnormal cardiovascular imaging was the most commonly cited indication for PVR (n = 61/123, 50%). The SAS class and ratio of right to left end-diastolic volumes were independent predictors of PVR in a multivariable analysis (hazard ratio, 3.33; 95% confidence interval, 1.92-5.8, P < .0001; hazard ratio, 2.78; 95% confidence interval, 2.18-3.55, P < .0001). Conclusions: Although a majority of patients met guideline criteria for PVR, only a minority were referred for intervention. Abnormal cardiovascular imaging was the most common indication for referral. Further research will be necessary to establish the longer-term clinical impact of varying PVR referral strategies.
KW - cardiac MRI
KW - guidelines
KW - pulmonary valve replacement
KW - tetralogy of Fallot
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UR - http://www.scopus.com/inward/citedby.url?scp=85181835274&partnerID=8YFLogxK
U2 - 10.1016/j.xjon.2023.11.013
DO - 10.1016/j.xjon.2023.11.013
M3 - Article
C2 - 38420530
AN - SCOPUS:85181835274
SN - 2666-2736
VL - 17
SP - 215
EP - 228
JO - JTCVS Open
JF - JTCVS Open
ER -