Improved exercise performance and quality of life after percutaneous pulmonary valve implantation Jan Müller ⁎, Andrea Engelhardt, Sohrab Fratz, Andreas Eicken, Peter Ewert, Alfred Hager Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Germany abstract article info Article history: Received 20 June 2013 Received in revised form 20 January 2014 Accepted 1 March 2014 Available online 5 March 2014 Keywords: Congenital heart disease PPVI Melody® Sapien® Cardiopulmonary exercise test Quality of life Intervention Percutaneous pulmonary valve implantation Objective: Percutaneous pulmonary valve implantation (PPVI) has emerged as a new approach to treat patients with dysfunctional pulmonary valve conduits. Short- and midterm results have outlined hemodynamic improvements and increase in exercise performance. However, there is a lack of knowledge about quality of life at short term follow-up. Patients and methods: From July 2007 to March 2013, we investigated 59 patients (17 female; median age 22.8 years) undergoing PPVI in our institution. 46 had predominant pulmonary stenosis (PS) and 13 had pre- dominant pulmonary regurgitation (PR). They answered the quality of life questionnaire (SF-36) and underwent a cardiopulmonary exercise test and Cardiovascular Magnetic Resonance before and 6 months after PPVI. Results: Peak oxygen uptake improved significantly from 27.2 (18.9; 34.0) ml/min/kg to 29.2 (22.4; 35.3) ml/min/kg (p b .0001), and from 69.6 (55.9; 83.6) %predicted to 76.3 (67.9; 92.7) %predicted, respectively. Improvements were seen in both, the PS (71.9 to 78.3 %predicted; p b .0001) and PR (62.7 to 73.0 %predicted; p b .0001) group. Self-estimated quality of life was good already before PPVI but increased in almost all domains 6 months after PPVI in PS and PR group. Significant improvements developed in “physical function”, “general health perception” and “health transition” in both groups, and “physical role functioning”, “vitality” and “mental health” only in the PS group. Conclusions: In patients with dysfunctional pulmonary valve conduits exercise performance and quality of life improve substantially 6 months after successful percutaneous pulmonary valve implantation. © 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Percutaneous pulmonary valve implantation (PPVI) is a new treat- ment option for selected patients with dysfunctional right ventricular to pulmonary artery conduits [1]. During PPVI, the degenerated pulmonary valve is overstented using either a, in a stent mounted, bovine jugular vein (Melody®) or a bovine pericardial valve (Sapien®). Short and midterm follow-ups of patients after PPVI have shown improved and sustained hemodynamics and an increase in exercise capacity, especially in those patients with predominant pulmonary stenosis before intervention [2–5]. However, there is a lack of knowledge about quality of life changes with this procedure and how the patients themselves report the results of the procedure. 2. Patients and methods 2.1. Study subjects rFrom July 2007 to March 2013 we prospectively investigated all 128 consecutive pa- tients undergoing PPVI at our institution (Fig. 1). In 20 patients the 6 month follow-up is still pending. 22 patients were lost for the ini- tial or follow-up investigation (11 patients from abroad). Two patients died. In those 84 patients eligible at follow-up 18 patients were younger than 14 years and not included into the study because the quality of life instrument is not validated for children. Further- more, 7 patients with syndromes (Down syndrome, 22q11) or psychomotor disability had to be excluded. Our inclusion criteria for PPVI were described previously [2]. In total 59 patients (17 female, median: 22.8 (1st quartile: 17.0; 3rd quartile: 29.7) years) received a quality of life assessment and a cardiopulmonary exercise test (CPET) 1 (1; 20) day before PPVI and 6.2 (5.8; 6.7) months after PPVI (Tables 1a and 1b). The in- dication for PPVI was isolated stenosis in 39 patients (peak instantaneous pressure gradi- ent N50 mm Hg at echocardiography) and isolated pulmonary regurgitation (N25% at cardiovascular magnetic resonance) in 9 patients. A mixed conduit dysfunction was pres- ent in 11 patients. From those 11 patients seven were assigned to the stenosis group and four to the regurgitation group according to their predominant indication derived from Cardiovascular Magnetic Resonance or echocardiography (Tables 1a and 1b). Of the total 59 patients, 30 patients had repaired tetralogy of Fallot followed by a con- duit replacement, 10 had a common arterial trunk with a conduit repair, 2 pulmonary ste- nosis with a preceding conduit repair, 7 aortic stenosis with preceding Ross procedure, 3 patients with congenitally corrected transposition of the great arteries, and 7 patients with transposition of the great arteries after Rastelli procedure. International Journal of Cardiology 173 (2014) 388–392 ⁎ Corresponding author at: Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr, 36, D-80636 München, Germany. Tel.: +49 89 1218 3009; fax: +49 89 1218 3003. E-mail address: j.mueller@tum.de (J. Müller). http://dx.doi.org/10.1016/j.ijcard.2014.03.002 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved. 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