Objectives:
Homograft or bioprosthetic valve have been preferred in pulmonic
position in patients with congenital heart disease. However,
unsatisfactory results of these valves in durability make revival of
mechanical valve these days. The aim of this study is to investigate long-
term outcomes of mechanical valve implantation in pulmonic position.
Methods:
Between October 1988 and February 2011, 37 patients
underwent 38 mechanical pulmonary valve replacement (PVR). The
records
were reviewed retrospectively. There were 27 males (73%) and 10
females (27%). Median age was 13.5 years (range, 7 months to 23
years) and median prior operations was 2 (range 0 to 5).
Tetralogy of Fallot (including pulmonary atresia) was the most common
diagnosis (n=32). Median valve size was 23mm (range 17 to 27mm).
Median follow-up duration was 24.6 months (range 1.3 months to 22.5
years). Events were defined as mortality, reoperation, thromboembolism
and bleeding.
Results:
There was no in-hospital mortality. There were two late deaths (one heart failure and one traffic accident at postoperative 10.8 and 103.9
months). Excluding 1 patient who died of traffic accident, survival rate
was 97%, 97% and 97% at 1, 5 and 10 years. Freedom from
thromboembolic and bleeding events was 91.7%, 91.7% and 91.7% at 1,
5 and 10 years. There were two reoperation at postoperative 81.3 and
122.6 months. Freedom from reoperation was 100%, 100% and 83.3%
at 1, 5 and 10 years.
Conclusions:
Durability of mechanical valve in pulmonic position was excellent.
Thromboembolic or bleeding events due to anticoagulation are rare.
In growing patients who need PVR, mechanical valve could be an
attracting option.
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