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Mechanical valves in the pulmonary position: An international retrospective analysis

Pragt, H., van Melle, J. P., Javadikasgari, H., Seo, D. M., Stulak, J. M., Knez, I., Hoerer, J., Munoz-Guijosa, C., Dehaki, M. G., Shin, H. J., Dearani, J. A., Dehaki, M. G., Pieper, P. G., Eulenburg, C., Dos, L. & Ebels, T., Oct-2017, In : JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. 154, 4, p. 1371-1378.e1 9 p.

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  • Mechanical valves in the pulmonary position

    Final publisher's version, 835 KB, PDF document

DOI

  • Hanna Pragt
  • Joost P. van Melle
  • Hoda Javadikasgari
  • Dong Man Seo
  • John M. Stulak
  • Igor Knez
  • Juergen Hoerer
  • Christian Munoz-Guijosa
  • Mahyar G. Dehaki
  • Hong Ju Shin
  • Joseph A. Dearani
  • Maziar G. Dehaki
  • Petronella G. Pieper
  • Christine Eulenburg
  • Laura Dos
  • Tjark Ebels

Objective: Life expectancy of patients with congenital heart disease has improved over the past decades, increasing the need for a durable pulmonary prosthetic valve. Biological valves in various forms have become the valve of choice for pulmonary valve replacement (PVR), but structural valve deterioration is unavoidable in the long term. Use of a mechanical valve could be an alternative, but data on long-term outcomes are sparse.

Methods: We retrospectively collected and analyzed data on 364 patients with mechanical valves implanted in the pulmonary position between 1965 and 2014. The data originate from medical centers in Barcelona (Spain), Graz (Austria), Groningen (the Netherlands), Munich (Germany), Rochester (United States), Seoul (Republic of Korea), and Tehran (Iran).

Results: Median follow-up duration was 4.26 years (range, 0-27 years), mean age at implantation was 27.16 +/- 12.2 years. Tetralogy of Fallot was the most common primary cardiac diagnosis, with a subgroup of 69.8%. Freedom from valvular thrombosis was 91% (95% confidence interval [CI], 87%-94%) at 5 years and 86% (95% CI, 81%-91%) at 10 years post-PVR. With a success rate up to 88%, thrombolysis was a successful therapy. Freedom from reoperation was 97% (95% CI, 94%-99%) at 5 years post-PVR and 91% (95% CI, 85%95%) at 10 years.

Conclusions: Mechanical PVR is associated with a limited risk of valvular thrombosis. Thrombolysis was an effective treatment in the majority.

Original languageEnglish
Pages (from-to)1371-1378.e1
Number of pages9
JournalJOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
Volume154
Issue number4
Publication statusPublished - Oct-2017

    Keywords

  • congenital heart disease, mechanical heart valve pulmonary valve replacement, CONGENITAL HEART-DISEASE, TERM-FOLLOW-UP, INFECTIVE ENDOCARDITIS, 20-YEAR EXPERIENCE, REPLACEMENT, PROSTHESES, OUTCOMES, CARBOMEDICS, FALLOT, PERFORMANCE

ID: 49428381