Pulmonary valve replacement-A 10-year single-center surgical experience in ACHD patients

• Published in: PloS one 2024-10, Vol.19 (10), p.e0310700
• Main Authors: Peivandi, Armin Darius, Martens, Sven, Gion, Anaïs, Rukosujew, Andreas, Martens, Sabrina
• Format: Article
• Language: English
• Subjects: Adult; Cardiovascular disease; Cardiovascular diseases; Care and treatment; Congenital diseases; Congenital heart disease; Coronary vessels; Diagnosis; Echocardiography; Evaluation; Female; Health aspects; Heart; Heart Defects, Congenital - surgery; Heart diseases; Heart Valve Prosthesis Implantation - methods; Heart valve replacement; Hospital Mortality; Hospitals; Humans; Intervention; Magnetic Resonance Imaging; Male; Middle Aged; Mortality; Normality; Ostomy; Patient outcomes; Patients; Pulmonary valve; Pulmonary Valve - diagnostic imaging; Pulmonary Valve - surgery; Pulmonary Valve Insufficiency - diagnostic imaging; Pulmonary Valve Insufficiency - surgery; Retrospective Studies; Rheumatic heart disease; Statistical analysis; Surgery; Surgical techniques; Tetralogy of Fallot; Tetralogy of Fallot - diagnostic imaging; Tetralogy of Fallot - mortality; Tetralogy of Fallot - surgery; Treatment Outcome; Tricuspid valve
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0310700

Large-scale analyses of surgical outcomes after surgical pulmonary valve replacement (sPVR) as part of re-do surgery in adults with congenital heart disease (ACHD) are rare. Therefore, we present our outcomes of sPVR in ACHD patients over the last decade and demonstrate our standardized surgical approach. All ACHD patients who underwent sPVR between January 2013 and August 2022 were included. Primary diagnoses, peri-operative data, post-operative echocardiography, pre- and post-operative RV MRI and in-hospital mortality were examined. Pre- and postoperative MRI parameters were compared using paired testing. Standardized surgery was documented. Normality of continuous variables was tested using Shapiro-Wilk test. 79 patients (male 59.5% (n = 47), 71 re-operations (89.9%)) at a median age of 41.7 (52.2-28.8) years were included. Main underlying disease was Tetralogy of Fallot (TOF; n = 47, 59.5%). After removal of degenerated valve/conduit parts, right ventricular outflow tract (RVOT) patch augmentation and implantation of a larger stented bioprosthesis (25mm in 78.5%) were conducted. In 57% of cases, concomitant surgery was performed (mainly tricuspid valve surgery: n = 28, 35.4%). 25 patients (31.6%) were operated with beating heart technique. Echocardiographic outcomes showed no moderate or severe insufficiency (median Vmax of 2 m/s (2.3-1.77 m/s)) upon discharge. Available MRI data showed significantly lower indexed RV-EDV (p = 0.0006) and RV-ESV (P = 0.0017) after surgery. In-hospital mortality was 5.1% (n = 4). SPVR is a safe therapeutic option with low surgical risk and satisfying post-operative results. It can serve as a solid therapeutic option for patients who need future valve-in-valve interventions.