Pulmonary valve replacement function in adolescents: a comparison of bioprosthetic valves and homograft conduits.

Abstract

Data comparing function and reintervention rates of various pulmonary valve replacements in adolescents are sparse. New transcatheter therapies-including transcatheter pulmonary valves-have been developed, and their utilization could be justified by these data. We performed a retrospective review that included baseline and operative data with cross-sectional follow-up on adolescents aged 10 to 21 years who underwent pulmonary valve replacement (n=254). We compared homograft conduits (n=84) with bioprosthetic pulmonary valves (n=170) in terms of freedom from valve dysfunction--right ventricular outflow tract obstruction greater than 50 mm Hg, or moderate or greater pulmonary regurgitation--and reintervention. Median follow-up duration was 4.4 years and was longer in the homograft cohort. Freedom from valvar dysfunction was 72%±4% at 5 years and 48%±8% at 10 years. Freedom from right ventricular outflow tract reintervention was 90%±3% at 5 years, 67%±5% at 10 years, and 47%±8% at 15 years. No differences existed for dysfunction or reintervention between the homograft and bioprosthetic valve cohorts. Shorter freedom from dysfunction was associated with younger age, smaller implanted valve Z-score, valve replacement after prior homograft, and higher preoperative right ventricular outflow tract (RVOT) gradient. Shorter freedom from reintervention was associated with younger age, smaller implanted valve Z-score, and more recent valve implant. Adolescents represent an important age group as an increasing number are undergoing pulmonary valve replacement, and they may be particularly impacted by new transcatheter therapies. This study provides baseline comparative data for current surgical options that should help inform medical decision making as longer term data become available for transcatheter pulmonary valve replacement and other new technologies.