Hendrik G Freling1, Ymkje J van Slooten2, Joost P van Melle3, Tjark Ebels4, Elke S Hoendermis3, Rolf M F Berger5, Hans L Hillege6, Tjalling W Waterbolk4, Dirk J van Veldhuisen7, Tineke P Willems8, Petronella G Pieper9. 1. Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands. 2. Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands; Department of Thoracic Surgery, University Medical Center Groningen, Groningen, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands. 3. Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands. 4. Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Thoracic Surgery, University Medical Center Groningen, Groningen, the Netherlands. 5. Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Pediatric Cardiology, University Medical Center Groningen, Groningen, the Netherlands. 6. Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands. 7. Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands. 8. Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands. 9. Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: p.g.pieper@umcg.nl.
Abstract
BACKGROUND: Although the thromboembolic risk after pulmonary valve replacement (PVR) with mechanical valves is presumed to be high, recent studies suggest promising short-term and mid-term results. However, large studies reporting long-term mortality and valve-related complications are missing. METHODS: We describe valve-related complications in 66 patients with a mechanical pulmonary valvar prosthesis implanted between 1987 and 2013. RESULTS: Mean follow-up duration was 5.9 ± 4.8 years (median 4.9). Mean age at time of implantation was 35 ± 13 years. The most frequent underlying cardiac diagnosis was tetralogy of Fallot (77%). Valvar thrombosis or pannus was reported in 7 patients (10%) of which 4 in the setting of inadequate anticoagulation or pregnancy. Redo PVR was performed in 6 patients. Freedom from redo PVR in survivors after 5 and 10 years was 96% and 89%, respectively. Survival after 5 and 10 years was 91% and 81%, respectively. Main cause of death was end-stage heart failure. CONCLUSIONS: Success of PVR using mechanical valvar prostheses over 26 years was limited because of valvar thrombosis (often in the setting of pregnancy or incompliance with anticoagulation therapy) or pannus. Performance of mechanical prostheses in the pulmonary position may improve when valvar thrombosis is prevented by patient selection, avoiding mechanical valves in patients at increased risk of valvar thrombosis, and by strict compliance to anticoagulation therapy.
BACKGROUND: Although the thromboembolic risk after pulmonary valve replacement (PVR) with mechanical valves is presumed to be high, recent studies suggest promising short-term and mid-term results. However, large studies reporting long-term mortality and valve-related complications are missing. METHODS: We describe valve-related complications in 66 patients with a mechanical pulmonary valvar prosthesis implanted between 1987 and 2013. RESULTS: Mean follow-up duration was 5.9 ± 4.8 years (median 4.9). Mean age at time of implantation was 35 ± 13 years. The most frequent underlying cardiac diagnosis was tetralogy of Fallot (77%). Valvar thrombosis or pannus was reported in 7 patients (10%) of which 4 in the setting of inadequate anticoagulation or pregnancy. Redo PVR was performed in 6 patients. Freedom from redo PVR in survivors after 5 and 10 years was 96% and 89%, respectively. Survival after 5 and 10 years was 91% and 81%, respectively. Main cause of death was end-stage heart failure. CONCLUSIONS: Success of PVR using mechanical valvar prostheses over 26 years was limited because of valvar thrombosis (often in the setting of pregnancy or incompliance with anticoagulation therapy) or pannus. Performance of mechanical prostheses in the pulmonary position may improve when valvar thrombosis is prevented by patient selection, avoiding mechanical valves in patients at increased risk of valvar thrombosis, and by strict compliance to anticoagulation therapy.
Authors: Sarah E Motta; Emanuela S Fioretta; Petra E Dijkman; Valentina Lintas; Luc Behr; Simon P Hoerstrup; Maximilian Y Emmert Journal: J Cardiovasc Transl Res Date: 2018-03-20 Impact factor: 4.132
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