Surgical pulmonary valve replacement at a tertiary adult congenital heart centre in the current era

Abstract

Background: Surgical pulmonary valve replacement (PVR) is the standard cardiac operation in adult patients with congenital heart disease (ACHD). We report recent experience at a large tertiary centre and examine the impact of prosthesis type on outcomes. Methods: All surgical PVRs performed at our tertiary centre between January 2003 and December 2018 were included. Results: The study population included 490 patients (197 women; mean age 29.9 ± 13 years). The types of valves used were Homograft 179 (37%), Perimount 152 (31%), Mosaic 120 (24%), Hancock 31 (6%), and others 5 (1%). Seven (1.4%) early deaths occurred within 30 days after surgery. The survival rates at 1, 5, 10, and 15 years of follow-up were 98.3%, 97.7%, 96.8%, and 95.4%, respectively, whereas freedom from re-intervention was 99.8%, 96.6%, 90.2%, and 81.0%, respectively. During a mean follow-up of 6.5 ± 4.3 years, 27 (5.5%) patients required re-intervention. The type of valve used in these 27 patients during index operation showed no discernible difference in the probability of re-intervention; however, Mosaic valves required earlier re-intervention compared to Perimount valves. Conclusion: Our data show no discernible difference in reoperation rates between the different types of prostheses used. On-going surveillance of patients after PVR and further research in developing a life-long prosthesis are clearly warranted.

Keywords

• Pulmonary valve replacement
• Tetralogy of fallot
• Adult congenital heart disease