Assessment of the longevity of valves placed in the pulmonary position in patients with congenital heart disease

Juanita Hunter, Eliot Rosenkranz, Hua Li, Sethuraman Swaminathan

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Pulmonary valve replacement is often performed in patients with complex congenital heart disease with pathology involving the right ventricular outflow tract. Progressive valve dysfunction is a well-described phenomenon. The aim of this study was to compare the longevity of homograft and bioprosthetic valves placed in the pulmonary position and to determine factors influencing valve dysfunction. We conducted a retrospective chart review of all patients who underwent surgical pulmonary valve replacement with homograft or bioprosthetic (bovine pericardial or porcine) valves during the period January 2000 through December 2013 (n = 81). Serial echocardiographic data and the time to valve dysfunction were reviewed as well as factors associated with valve dysfunction and/or re-intervention. There was a shorter time to valve dysfunction in the homograft valve group as compared to the bioprosthetic valve group. Freedom from valve dysfunction was 63% at 1 year, 38% at 5 years and 29% at 10 years in the homograft group compared to 96% at 1 year, 77% at 5 years and 52% at 10 years in the bioprosthetic valve group. However, on subgroup analysis, age at surgery was strongly associated with time to valve dysfunction, with older age being more protective (chi square with one degree of freedom = 23.42; p ≤ 0.0001; hazard ratio 0.857). When adjusted for age, there was no significant difference in freedom from valve dysfunction between the two valve types (chi square with one degree of freedom = 0.031; p = 0.86). Overall, the longevity of bioprosthetic valve and homograft valve used in right ventricular outflow surgery is largely dependent on the age of valve implantation with no difference in valve performance between valve types.

Original languageEnglish (US)
Pages (from-to)133-139
Number of pages7
JournalProgress in Pediatric Cardiology
Volume43
DOIs
StatePublished - Dec 1 2016

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Allografts
Heart Diseases
Lung
Pulmonary Valve
Surgical Instruments
Swine
Pathology

Keywords

  • Bioprosthetic pulmonary valve
  • Pulmonary homograft
  • Pulmonary valve replacement
  • Tetralogy of Fallot

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Assessment of the longevity of valves placed in the pulmonary position in patients with congenital heart disease",
abstract = "Pulmonary valve replacement is often performed in patients with complex congenital heart disease with pathology involving the right ventricular outflow tract. Progressive valve dysfunction is a well-described phenomenon. The aim of this study was to compare the longevity of homograft and bioprosthetic valves placed in the pulmonary position and to determine factors influencing valve dysfunction. We conducted a retrospective chart review of all patients who underwent surgical pulmonary valve replacement with homograft or bioprosthetic (bovine pericardial or porcine) valves during the period January 2000 through December 2013 (n = 81). Serial echocardiographic data and the time to valve dysfunction were reviewed as well as factors associated with valve dysfunction and/or re-intervention. There was a shorter time to valve dysfunction in the homograft valve group as compared to the bioprosthetic valve group. Freedom from valve dysfunction was 63{\%} at 1 year, 38{\%} at 5 years and 29{\%} at 10 years in the homograft group compared to 96{\%} at 1 year, 77{\%} at 5 years and 52{\%} at 10 years in the bioprosthetic valve group. However, on subgroup analysis, age at surgery was strongly associated with time to valve dysfunction, with older age being more protective (chi square with one degree of freedom = 23.42; p ≤ 0.0001; hazard ratio 0.857). When adjusted for age, there was no significant difference in freedom from valve dysfunction between the two valve types (chi square with one degree of freedom = 0.031; p = 0.86). Overall, the longevity of bioprosthetic valve and homograft valve used in right ventricular outflow surgery is largely dependent on the age of valve implantation with no difference in valve performance between valve types.",
keywords = "Bioprosthetic pulmonary valve, Pulmonary homograft, Pulmonary valve replacement, Tetralogy of Fallot",
author = "Juanita Hunter and Eliot Rosenkranz and Hua Li and Sethuraman Swaminathan",
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AU - Li, Hua

AU - Swaminathan, Sethuraman

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N2 - Pulmonary valve replacement is often performed in patients with complex congenital heart disease with pathology involving the right ventricular outflow tract. Progressive valve dysfunction is a well-described phenomenon. The aim of this study was to compare the longevity of homograft and bioprosthetic valves placed in the pulmonary position and to determine factors influencing valve dysfunction. We conducted a retrospective chart review of all patients who underwent surgical pulmonary valve replacement with homograft or bioprosthetic (bovine pericardial or porcine) valves during the period January 2000 through December 2013 (n = 81). Serial echocardiographic data and the time to valve dysfunction were reviewed as well as factors associated with valve dysfunction and/or re-intervention. There was a shorter time to valve dysfunction in the homograft valve group as compared to the bioprosthetic valve group. Freedom from valve dysfunction was 63% at 1 year, 38% at 5 years and 29% at 10 years in the homograft group compared to 96% at 1 year, 77% at 5 years and 52% at 10 years in the bioprosthetic valve group. However, on subgroup analysis, age at surgery was strongly associated with time to valve dysfunction, with older age being more protective (chi square with one degree of freedom = 23.42; p ≤ 0.0001; hazard ratio 0.857). When adjusted for age, there was no significant difference in freedom from valve dysfunction between the two valve types (chi square with one degree of freedom = 0.031; p = 0.86). Overall, the longevity of bioprosthetic valve and homograft valve used in right ventricular outflow surgery is largely dependent on the age of valve implantation with no difference in valve performance between valve types.

AB - Pulmonary valve replacement is often performed in patients with complex congenital heart disease with pathology involving the right ventricular outflow tract. Progressive valve dysfunction is a well-described phenomenon. The aim of this study was to compare the longevity of homograft and bioprosthetic valves placed in the pulmonary position and to determine factors influencing valve dysfunction. We conducted a retrospective chart review of all patients who underwent surgical pulmonary valve replacement with homograft or bioprosthetic (bovine pericardial or porcine) valves during the period January 2000 through December 2013 (n = 81). Serial echocardiographic data and the time to valve dysfunction were reviewed as well as factors associated with valve dysfunction and/or re-intervention. There was a shorter time to valve dysfunction in the homograft valve group as compared to the bioprosthetic valve group. Freedom from valve dysfunction was 63% at 1 year, 38% at 5 years and 29% at 10 years in the homograft group compared to 96% at 1 year, 77% at 5 years and 52% at 10 years in the bioprosthetic valve group. However, on subgroup analysis, age at surgery was strongly associated with time to valve dysfunction, with older age being more protective (chi square with one degree of freedom = 23.42; p ≤ 0.0001; hazard ratio 0.857). When adjusted for age, there was no significant difference in freedom from valve dysfunction between the two valve types (chi square with one degree of freedom = 0.031; p = 0.86). Overall, the longevity of bioprosthetic valve and homograft valve used in right ventricular outflow surgery is largely dependent on the age of valve implantation with no difference in valve performance between valve types.

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