Iranian Heart Journal

Iranian Heart Journal

Clinical Outcomes of Mechanical and Bioprosthetic Pulmonary Valve Replacement During Mid to Long-term Follow-up in a Single Tertiary Center for Congenital Heart Disease

Document Type : Original Article

Authors
Zahra Khajali 1
Fateme Jorfi 1
Niloufar Samiei 1
Majid Maleki 2
Sedighe Saedi 1
Behshid Ghadrdoost 1
Maryam Keshavarz hedayati 3
1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
2 Cardiovascular Intervention Research Center Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
3 Qazvin University of Medical Sciences, Qazvin, IR Iran.
Abstract
Background: Pulmonary valve replacement (PVR) is frequently performed during the correction of various congenital heart disease. Pulmonary valve substitutes include bioprostheses, homografts, and mechanical valves. Among these, bioprosthetic valves are probably the most widely used because they are readily available and they do not need lifelong anticoagulation therapy. However, most of these bioprostheses will fail and require replacement mainly due to structural valve degeneration.
 
Methods: We retrospectively identified all patients who had undergone PVR at Rajaie Cardiovascular Medical and Research Center between 2010 and 2017. Medical records were reviewed for demographic and clinical information and follow-up imaging results.
 
Results: A total of 435 patients were eligible, and they had regular follow-ups after PVR based on their medical records. Mechanical valves were used for 66% of the patients (n=288) at first PVR and bioprosthetic valves for 34% of the patients. Forty-five patients with mechanical pulmonary valves (15%) received at least 1 thrombolytic therapy due to prosthetic valve thrombosis. Seventeen patients needed redo PVR, and 28 patients (62%) had successful thrombolytic therapy. There was no significant association between redo PVR and the prosthetic valve size (P=0.7) or the valve type (P=0.07), although the percentage of patients with first bioprosthetic valves who needed redo PVR was almost twice that of patients with first mechanical valves (13.4% vs 5.9%).
 
Conclusions: A mechanical valve can be a promising option for PVR in selected patients. (Iranian Heart Journal 2021; 22(4): 66-70)
Keywords
Congenital heart disease
Mechanical valve
Pulmonary valve
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Iranian Heart Journal
Volume 22, Issue 4
Autumn 2021
Pages 66-70