Pulmonary Valve Replacement: A Comparison of Three Biological Valves

Andrew C. Fiore, Mark Rodefeld, Mark Turrentine, Palaniswamy Vijay, Tyler Reynolds, John Standeven, Kirstin Hill, Jamie Bost, Dustin Carpenter, Courtney Tobin, John W. Brown

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background: We retrospectively reviewed the performance of the mosaic porcine, bovine pericardial, and homograft prostheses for pulmonary valve replacement to correct chronic pulmonary insufficiency. Methods: From January 1995 to August 2006, 82 patients (mean age, 22.7 years) underwent valve replacement with porcine (49 patients), bovine pericardial (18 patients), or pulmonary homograft (15 patients) prosthesis at a mean of 15.3 years after initial outflow tract reconstruction. Excluded were patients with extracardiac conduits, monocusp valves, or the Ross procedure. The groups were similar with respect to age, body surface area, degree of regurgitation, right ventricular dimension, right ventricular to pulmonary artery gradient, and valve size. Follow-up was longer in the homograft cohort (porcine, 20 ± 27 months; pericardial, 42 ± 21; homograft, 49 ± 40; p < 0.01). Results: All three prostheses significantly reduce chronic pulmonary regurgitation, but late insufficiency was higher with homografts. Right ventricular dimension was significantly reduced in the stented but not the allograft cohorts. Late valve dysfunction was highest with homografts (54%), followed by porcine (19%) and pericardial valves (5.5%; p < 0.05. Functional class and mild to moderate tricuspid insufficiency significantly improved with pulmonary valve replacement. Early and late mortality was 3.6% and 1.2%, respectively. Conclusions: All three prostheses performed similarly for 3 years. Pulmonary regurgitation developed more frequently in homografts albeit at a longer duration of follow-up.

Original languageEnglish (US)
Pages (from-to)1712-1718
Number of pages7
JournalAnnals of Thoracic Surgery
Volume85
Issue number5
DOIs
StatePublished - May 1 2008

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Pulmonary Valve
Allografts
Prostheses and Implants
Swine
Pulmonary Valve Insufficiency
Lung
Body Surface Area
Pulmonary Artery
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Pulmonary Valve Replacement : A Comparison of Three Biological Valves. / Fiore, Andrew C.; Rodefeld, Mark; Turrentine, Mark; Vijay, Palaniswamy; Reynolds, Tyler; Standeven, John; Hill, Kirstin; Bost, Jamie; Carpenter, Dustin; Tobin, Courtney; Brown, John W.

In: Annals of Thoracic Surgery, Vol. 85, No. 5, 01.05.2008, p. 1712-1718.

Research output: Contribution to journalArticle

Fiore, AC, Rodefeld, M, Turrentine, M, Vijay, P, Reynolds, T, Standeven, J, Hill, K, Bost, J, Carpenter, D, Tobin, C & Brown, JW 2008, 'Pulmonary Valve Replacement: A Comparison of Three Biological Valves', Annals of Thoracic Surgery, vol. 85, no. 5, pp. 1712-1718. https://doi.org/10.1016/j.athoracsur.2008.02.001
Fiore, Andrew C. ; Rodefeld, Mark ; Turrentine, Mark ; Vijay, Palaniswamy ; Reynolds, Tyler ; Standeven, John ; Hill, Kirstin ; Bost, Jamie ; Carpenter, Dustin ; Tobin, Courtney ; Brown, John W. / Pulmonary Valve Replacement : A Comparison of Three Biological Valves. In: Annals of Thoracic Surgery. 2008 ; Vol. 85, No. 5. pp. 1712-1718.
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AU - Standeven, John

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AB - Background: We retrospectively reviewed the performance of the mosaic porcine, bovine pericardial, and homograft prostheses for pulmonary valve replacement to correct chronic pulmonary insufficiency. Methods: From January 1995 to August 2006, 82 patients (mean age, 22.7 years) underwent valve replacement with porcine (49 patients), bovine pericardial (18 patients), or pulmonary homograft (15 patients) prosthesis at a mean of 15.3 years after initial outflow tract reconstruction. Excluded were patients with extracardiac conduits, monocusp valves, or the Ross procedure. The groups were similar with respect to age, body surface area, degree of regurgitation, right ventricular dimension, right ventricular to pulmonary artery gradient, and valve size. Follow-up was longer in the homograft cohort (porcine, 20 ± 27 months; pericardial, 42 ± 21; homograft, 49 ± 40; p < 0.01). Results: All three prostheses significantly reduce chronic pulmonary regurgitation, but late insufficiency was higher with homografts. Right ventricular dimension was significantly reduced in the stented but not the allograft cohorts. Late valve dysfunction was highest with homografts (54%), followed by porcine (19%) and pericardial valves (5.5%; p < 0.05. Functional class and mild to moderate tricuspid insufficiency significantly improved with pulmonary valve replacement. Early and late mortality was 3.6% and 1.2%, respectively. Conclusions: All three prostheses performed similarly for 3 years. Pulmonary regurgitation developed more frequently in homografts albeit at a longer duration of follow-up.

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