Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Dec 2019)

Long‐Term Comparison Between Pulmonary Homograft Versus Bioprosthesis for Pulmonary Valve Replacement in Tetralogy of Fallot

  • Lucia Cocomello,
  • Marco Meloni,
  • Filippo Rapetto,
  • Mai Baquedano,
  • Maria Victoria Ordoñez,
  • Giovanni Biglino,
  • Chiara Bucciarelli‐Ducci,
  • Andrew Parry,
  • Serban Stoica,
  • Massimo Caputo

DOI
https://doi.org/10.1161/JAHA.119.013654
Journal volume & issue
Vol. 8, no. 24

Abstract

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Background Tetralogy of Fallot repair results in late occurrence of pulmonary regurgitation, which requires pulmonary valve replacement in a large proportion of patients. Both homografts and bioprostheses are used for pulmonary valve replacement as uncertainty remains on which prosthesis should be considered superior. We performed a long‐term imaging and clinical comparison between these 2 strategies. Methods and Results We compared echocardiographic and clinical follow‐up data of 209 patients with previous tetralogy of Fallot repair who underwent pulmonary valve replacement with homograft (n=75) or bioprosthesis (n=134) between 1995 and 2018 at a tertiary hospital. The primary end point was the composite of pulmonary valve replacement reintervention and structural valve deterioration, defined as a transpulmonary pressure decrease ≥50 mm Hg or pulmonary regurgitation degree of ≥2. Mixed linear model and Cox regression model were used for comparisons. Echocardiographic follow‐up duration was longer in the homograft group (8 [interquartile range, 4–12] versus 4 [interquartile range, 3–6] years; P<0.001). At the latest echocardiographic follow‐up, homografts showed a significantly lower transpulmonary systolic pressure decrease (16 [interquartile range, 12–25] mm Hg) when compared with bioprostheses (28 [interquartile range, 18–41] mm Hg; mixed model P<0.001) and a similar degree of pulmonary regurgitation (degree 0‐4) (1 [interquartile range, 0–2] versus 2 [interquartile range, 0–2]; mixed model P=0.19). At 9 years, freedom from structural valve deterioration and reintervention was 81.6% (95% CI, 71.5%–91.6%) versus 43.4% (95% CI, 23.6%–63.2%) in the homograft and bioprosthesis groups, respectively (adjusted hazard ratio, 0.27; 95% CI, 0.13–0.55; P<0.001). Conclusions When compared with bioprostheses, pulmonary homografts were associated lower transvalvular gradient during follow‐up and were associated with a significantly lower risk of reintervention or structural valve degeneration.

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