1. Adherence to clinical practice guidelines for pulmonary valve intervention after tetralogy of Fallot repair: A nationwide cohort studyCentral MessagePerspective
- Author
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Danielle Massarella, MD, MSc, Brian W. McCrindle, MD, MPH, Kyle Runeckles, MSc, Steve Fan, PhD, Nagib Dahdah, MD, Frédéric Dallaire, MD, Christian Drolet, MD, Jasmine Grewal, MD, Camille L. Hancock-Friesen, MD, Edward Hickey, MD, Gauri Rani Karur, MD, Paul Khairy, MD, PhD, Benedetta Leonardi, MD, Michelle Keir, MD, Syed Najaf Nadeem, MD, Ming-Yen Ng, MD, Ashish Shah, MD, Edythe B. Tham, MBBS, Judith Therrien, MD, Andrew E. Warren, MD, Isabelle F. Vonder Muhll, MD, Alexander Van de Bruane, MD, Kenichiro Yamamura, MD, MSc, PhD, Michael Farkouh, MD, and Rachel M. Wald, MD
- Subjects
tetralogy of Fallot ,pulmonary valve replacement ,guidelines ,cardiac MRI ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
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
- Published
- 2024
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