Abstract
Pulmonary valve replacement (PVR) for pulmonary valve insufficiency (PVI) currently represents the most frequent reoperation performed for adults with congenital heart disease. A variety of pulmonary valve substitutes have been used, but none has proved to be ideal. This report reviews the authors’ experience using a porcine prosthetic valve in the pulmonary position. Between January 2001 and December 2011, 76 patients (mean age, 36 years; range, 18–64 years) underwent PVR for chronic PVI using a porcine bioprosthesis. All the patients had previously undergone surgery: 65 for repair of tetralogy of Fallot and 11 for pulmonary surgical valvotomy. Magnetic resonance imaging (MRI) evaluations before surgery and at the 1-year postoperative follow-up evaluation were compared. Aside from the PVR, 59 patients (59/65, 78 %) received 94 associated cardiac surgical procedures. Two hospital deaths occurred. The mean hospital stay was 13 days (range, 7–48 days). At the 1-year control MRI, pulmonary regurgitation fraction, right ventricular end diastolic volume (RVEDV), and RV/LV EDV had improved significantly. During a mean follow-up period of 52 months (range, 6–132 months), one patient died. All the patients were categorized as New York heart association (NYHA) functional class 1. No episodes of structural valve deterioration, endocarditis, or thromboembolic event were noted. Echocardiography showed trivial or no PVI in all the patients. The porcine bioprosthetic valves demonstrated excellent midterm results in the RV outflow tract reconstruction. The hemodynamic characteristics of this valve are comparable with those of homografts or valved conduits. It is easy to implant and allows for avoiding extensive dissection, especially of the pulmonary arteries.
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References
Fiore CA, Rodefeld M, Turrentine M, Vijay P, Reynolds T, Standeven J et al (2008) Pulmonary valve replacement: a comparison of three biological valves. Ann Thorac Surg 85:1712–1718
Fukada J, Morishita K, Komatsu K, Abe T (1997) Influence of pulmonic position on durability of bioprosthetic heart valve. Ann Thorac Surg 64:1678–1680
Giamberti A, Chessa M, Abella R, Butera G, Carlucci C, Nuri H et al (2009) Morbidity and mortality risk factors in adults with congenital heart disease undergoing cardiac reoperation. Ann Thorac Surg 88:1284–1289
Hawkins JA, Sower CT, Lambert LM, Kouretas PC, Burch PT, Keza PT et al (2009) Stentless porcine valves in the right ventricular outflow tract: improved durability? Eur J Cardiothorac Surg 35:600–605
Kanter KR, Budde JM, Parks WJ, Tam VK, Sharma S, Williams WH et al (2002) One hundred pulmonary valve replacements in children after relief of right ventricular outflow tract obstruction. Ann Thorac Surg 73:1801–1807
Lee C, Park CS, Lee CH, Kwak JG, Kim SJ, Shim WS et al (2011) Durability of bioprosthetic valves in the pulmonary position: long-term follow-up of 181 implants in patients with congenital heart disease. J Thorac Cardiovasc Surg 142:351–358
MacDonald ST, Carminati M, Butera G. (2011) Percutaneous implantation of an Edwards Sapien valve in a failing pulmonary bioprosthesis in palliated tetralogy of Fallot. Eur Heart J Epub ahead of print 27 January
Rosti L, Murzi B, Colli AM, Festa P, Redaelli S, Havelova L et al (1998) Mechanical valves in the pulmonary position: a reappraisal. J Thorac Cardiovasc Surg 115:1074–1079
Shinkawa T, Anagnostopoulos PV, Johnson NC, Watanabe N, Sapru A, Azakie A (2010) Performance of bovine pericardial valves in the pulmonary position. Ann Thorac Surg 90:1295–1300
Waterbolk TW, Hoendermis ES, den Hamer IJ, Ebels T (2006) Pulmonary valve replacement with a mechanical prosthesis: promising results of 28 procedures in patients with congenital heart disease. Eur J Cardiothorac Surg 30:28–32
Yemetz IM, Williams WG, Webb GD, Harrison DA, McLaughlin PR, Trusler GA et al (1997) Pulmonary valve replacement late after repair of tetralogy of Fallot. Ann Thorac Surg 64:526–530
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Giamberti, A., Chessa, M., Reali, M. et al. Porcine Bioprosthetic Valve in the Pulmonary Position: Mid-Term Results in the Right Ventricular Outflow Tract Reconstruction. Pediatr Cardiol 34, 1190–1193 (2013). https://doi.org/10.1007/s00246-012-0602-3
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DOI: https://doi.org/10.1007/s00246-012-0602-3