Pulmonary Valve Replacement: A Comparison of Three Biological Valves

Fiore, Andrew C.; Rodefeld, Mark D.; Turrentine, Mark W.; Vijay, Palaniswamy; Reynolds, Tyler R.; Standeven, John; Hill, Kirstin; Bost, Jamie; Carpenter, Dustin; Tobin, Courtney S. Thomas; Brown, John W.

doi:10.1016/j.athoracsur.2008.02.001

Cited by 75 publications

(62 citation statements)

References 18 publications

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“…110 We found one multicenter review, 3 some single center reviews, 1,2,4,79 and 3 case reports. 5,6,10 Infections of percutaneously placed PVs are of recent interest 1118 but are beyond the scope of this report.…”

Section: Discussionmentioning

confidence: 97%

Late Postoperative Prosthetic Pulmonary Valve Endocarditis in a 13-Year-Old Girl with Repaired Tetralogy of Fallot

O’Brien¹,

Pourmoghadam²,

DeCampli³

2015

Texas Heart Institute Journal

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Section: Discussionmentioning

confidence: 97%

Late Postoperative Prosthetic Pulmonary Valve Endocarditis in a 13-Year-Old Girl with Repaired Tetralogy of Fallot

O’Brien¹,

Pourmoghadam²,

DeCampli³

2015

Texas Heart Institute Journal

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“…27 To date, there is no ideal substitute pulmonary valve; therefore, many patients having PVR can expect to be burdened by further procedures. [28][29][30] Each reintervention carries a risk comparable to the mortality we would currently quote for the primary repair, so aggregated over a lifetime, the consequences of committing a patient at the time of their initial operation to later PVR are significant. Minimizing the burden of late PVR for patients requires addressing 2 uncertainties: how late-adult outcomes should affect decisions made at the time of primary repair and issues about the indications for late PVR.…”

Section: Discussionmentioning

confidence: 99%

Physiological and Phenotypic Characteristics of Late Survivors of Tetralogy of Fallot Repair Who Are Free From Pulmonary Valve Replacement

et al. 2013

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Background-Pulmonary valve replacement (PVR) after repair of tetralogy of Fallot is commonly required and is burdensome. Detailed anatomic and physiologic characteristics of survivors free from late PVR and with good exercise capacity are not well described in a literature focusing on the indications for PVR. Methods and Results-Survival and freedom from PVR were tracked in 1085 consecutive patients receiving standard tetralogy of Fallot repair in a single institution from 1964 to 2009. Of 152 total deaths, 100 occurred within the first postoperative year. Surviving patients between 10 and 50 years of age had an annual risk of death of 4 (confidence limit, 2.8-5.4) times that of normal contemporaries. To date, 189 patients have undergone secondary PVR at mean age of 20±13 years (36% of those alive at 40 years of age). A random sample of 50 survivors (age, 4-57 years) free from PVR underwent cardiovascular magnetic resonance, echocardiography, and exercise testing. These patients had mildly dilated right ventricles (right ventricular end-diastolic volume=101±26 mL/m 2 ) with good systolic function (right ventricular ejection fraction=59±7%). Most had exercise capacity within normal range (z peak V i o 2 =−0.91±1.3; z V i e/V i co 2 =0.20±1.5). In patients >35 years of age with normal exercise capacity, there was mild residual right ventricular outflow tract obstruction (mean gradient, 24±13 mm Hg), pulmonary annulus diameters <0.5z, and unobstructed branch pulmonary arteries. Conclusions-An important proportion of patients require PVR late after tetralogy of Fallot repair. Patients surviving to 35 years of age without PVR and with a normal exercise capacity may have had a definitive primary repair; their right ventricular outflow tracts are characterized by mild residual obstruction and pulmonary annulus diameter <0.5z.

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“…1,[14][15][16][17] However, the timing of PVR is still controversial because of the surgical risk and lack of prosthetic valve longevity. [11][12][13] Calderone et al reported that freedom from valve replacement was 82% at 5 years and 58% at 10 years in all age groups (median age 6.2 years), and that PVR at an early age is associated with a higher rate of valve failure and early reoperation. 12 Moreover, Fiore et al reported that freedom from valve replacement was 92% for bovine pericardial valves and 78% for porcine valves at 5 years in older age patients late after an initial outflow tract reconstruction (median age 22.7 years).…”

Section: Discussionmentioning

confidence: 99%

“…12 Moreover, Fiore et al reported that freedom from valve replacement was 92% for bovine pericardial valves and 78% for porcine valves at 5 years in older age patients late after an initial outflow tract reconstruction (median age 22.7 years). 13 Several reports suggest that early PVR with an RVEDVI <150-170 ml/m 2 prevents irreversible RV dysfunction and refractory arrhythmias and leads to normalization of the RV volumes. 1,[14][15][16] In our study, all 3 patients had a severely d-RV and RV dysfunction with refractory arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3]9,10 Pulmonary valve replacement (PVR) is an alternative solution for RV volume overload; however, the timing of PVR is still controversial because of the surgical risk and lack of prosthetic valve longevity. [11][12][13] Several reports have suggested that early PVR when the patient has an RV end-diastolic volume index (RVEDVI) less than 150-170 ml/m 2 prevents irreversible RV dysfunction and refractory arrhythmias and leads to the normalization of RV volumes. 1,[14][15][16] However, there are few studies that have investigated the efficacy of PVR in patients with a severely dilated RV (d-RV) after the repair of TOF.…”

mentioning

confidence: 99%

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Pulmonary Valve Replacement in Adult Patients With a Severely Dilated Right Ventricle and Refractory Arrhythmias After Repair of Tetralogy of Fallot

Miyazaki

Yamamoto

Sakaguchi

et al. 2009

Circ J

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Background: Refractory arrhythmias caused by right ventricular (RV) volume overload resulting from pulmonary regurgitation are the main concern in adult patients after repair of tetralogy of Fallot (TOF). Early pulmonary valve replacement (PVR) may prevent irreversible RV dysfunction and refractory arrhythmias, so the present study evaluated the PVR outcomes in adult patients with a severely dilated RV (d-RV) and refractory arrhythmias after TOF repair. Methods and Results: Three TOF patients with a d-RV and tachyarrhythmias underwent PVR between the ages of 28 and 38 years. All had a d-RV (RV end-diastolic volume index (RVEDVI) >200 ml/m 2 ) with a polymorphic nonsustained ventricular tachycardia (NSVT). Atrial tachycardia (AT) was identified in 2 patients and they underwent radiofrequency catheter ablation. The arrhythmias in all 3 were refractory to antiarrhythmic drugs. One year after PVR, the RVEDVI, left ventricular ejection fraction, right atrial pressure, cardiac index, cardiothoracic ratio, brain natriuretic peptide levels, and peak V• O2 improved in all, but without normalization. During the 2.6-3.8 year follow-up, all experienced tachyarrhythmias (NSVT or AT), which were controlled with medication. Conclusions: PVR may be beneficial for refractory arrhythmias, even in TOF patients with a d-RV, but it is difficult to completely normalize the hemodynamics and resolve the arrhythmogenicity. (Circ J 2009; 73: 2135 -2142

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Pulmonary Valve Replacement: A Comparison of Three Biological Valves

Cited by 75 publications

References 18 publications

Late Postoperative Prosthetic Pulmonary Valve Endocarditis in a 13-Year-Old Girl with Repaired Tetralogy of Fallot

Late Postoperative Prosthetic Pulmonary Valve Endocarditis in a 13-Year-Old Girl with Repaired Tetralogy of Fallot

Physiological and Phenotypic Characteristics of Late Survivors of Tetralogy of Fallot Repair Who Are Free From Pulmonary Valve Replacement

Pulmonary Valve Replacement in Adult Patients With a Severely Dilated Right Ventricle and Refractory Arrhythmias After Repair of Tetralogy of Fallot

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