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12.09.2018 | Original Article

Mid-term outcomes of mechanical pulmonary valve replacement: a single-institutional experience of 396 patients

Zeitschrift:
General Thoracic and Cardiovascular Surgery
Autoren:
Maziar Gholampour Dehaki, Alwaleed Al-Dairy, Yousef Rezaei, Gholamreza Omrani, Amir Hossein Jalali, Hoda Javadikasgari, Mahyar Gholampour Dehaki
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11748-018-1012-0) contains supplementary material, which is available to authorized users.

Abstract

Objectives

Previous small-sized studies have demonstrated the safety and efficacy of mechanical pulmonary valve replacement (mPVR) in patients with congenital heart disease; however, the predictors of major complications and reoperation remained unclear.

Methods

In a retrospective study, we reported the mid-term outcomes of a large-scaled series of patients, 396 patients, with congenital heart diseases who underwent mPVR in a single institution.

Results

The patients’ mean age at mPVR was 24.3 ± 9 years (4–58 years). Most patients (84.3%) underwent tetralogy of Fallot total correction. The median of follow-up was 36 months (24–49 months). Prosthetic valve malfunction caused by thrombosis or pannus formation developed in 12.1% of patients during follow-up period. Reoperation was performed in 7 cases with pannus formation and 6 cases with mechanical valve thrombosis. Freedom from reoperation at 1, 5, and 10 years was 99%, 97%, and 96%, respectively. Neither early nor mid-term mortalities were detected. Cox regression models showed that male gender and smaller valve size increased the risk of prosthetic valve failure. The age at mPVR, interval between congenital heart defect repair and mPVR, and concomitant procedures predicted reoperation. In multivariate analysis, younger age and the interval between first operation and mPVR predicted reoperation either.

Conclusions

The success rate of mPVR is excellent in mid-term follow-up. Younger age, longer interval between the repair of congenital defect and mPVR, and cooperation increased reoperation risk. However, strict adherence to life-long anticoagulation regimen and patient selection are of great importance for the implementation of mPVR.

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Zusatzmaterial
Supplement figure. Graphs showing difference concerning mechanical valve gradient between patients with or without (A) mechanical valve thrombosis and (B) PVM MPG=mean pressure gradient; PVM=pulmonary valve malfunction (TIF 1561 KB)
11748_2018_1012_MOESM1_ESM.tif
Supplementary material 2 (TIF 1594 KB)
11748_2018_1012_MOESM2_ESM.tif
Literatur
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