Abstract 3124: Impact of Age on Outcome of Pulmonary Valve Replacement for Pulmonary Regurgitation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Alessandra Frigiola ◽  
Victor Tsang ◽  
Johannes Nordmeyer ◽  
Philipp Lurz ◽  
Kate Bull ◽  
...  
Keyword(s):  
Ventricular Function ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Nyha Class ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement ◽  
End Diastolic Volume ◽  
Younger Age ◽  
Group 2 ◽  
Group 1

Objectives: Pulmonary valve replacement (PVR) for pulmonary regurgitation improves right ventricular function when performed relatively early. Effects on exercise performance are still controversial. Furthermore little attention has been given to the effects on left ventricular function. Methods: 60 patients (mean age 20.5 ± 10.4, 27 male, 77% tetralogy of Fallot) underwent pulmonary valve replacement (PVR). Indications for intervention were presence of severe PR (regurgitant fraction ≥ 35%) and RV/LV end-diastolic volume ≥1.5. Fifty-six patients had a pulmonary homograft (mean size 21.5±1.7 mm). Magnetic resonance imaging and cardiopulmonary exercise testing (CPEX) were performed prior to and 1 year after intervention. NYHA class was also recorded. Results: On a retrospective analysis, we found that Ve/VCO2 exercise parameter was most likely to normalize when PVR was performed at a younger age (< than 16 years, p=0.027). We therefore compared the results between the younger patients (group 1: n=24, 6 male, mean age of PVR 12±2.4 years) and the older patients (group 2: n=37, 21 male, mean age of PVR 26±10 years). Before intervention there were no differences in MR parameters. NYHA class was ≤ 2 in 83% of patients in group 1 vs 51% in group 2, p=0.01. Following PVR, only group 1 had a significant improvement in RV effective strove volume (40.9±8.7 to 47.1±7.1 mL/beat, p=0.001 vs 40.3±9.9 to 43.8±10.2, ns); in both groups there was a significant increase in LV end-diastolic volume, reflecting a better filling, and LV effective stroke volume (effSV), although these changes were more pronounced in group 1 (EDV: 11±11 vs 4±12 mL, p=0.041; effSV: 26±7 vs 19±11 mL/beat, p=0.025). Ve/VCO 2 improved significantly only in group 1 (33±3 to 30±4, p=0.015, vs 36±6 to 35±7, ns). Conclusions: PVR leads to a better RV and LV performance when performed at a younger age. This is mirrored by an improved Ve/VCO 2 exercise parameter which is more likely to normalize when surgery is performed prior to 16 year of age.

Porcine Versus Pericardial Pulmonary Valve Replacement in Adults With Prior Congenital Cardiac Surgery: Midterm Outcomes

2019 ◽  
Vol 10 (2) ◽  
pp. 197-205 ◽  
Author(s):  
Chi Sum Yuen ◽  
Kwok Fai Lucius Lee ◽  
Inderjeet Bhatia ◽  
Nicholson Yam ◽  
Barnabe Antonio Rocha ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement ◽  
Left Ventricular ◽  
Congenital Cardiac Surgery ◽  
Group 2 ◽  
Bioprosthetic Valves ◽  
Group 1

Background: Postcongenital heart surgery pulmonary regurgitation requires subsequent pulmonary valve replacement. We sought to compare the outcomes of pulmonary valve replacement after using bioprosthetic valves, porcine versus pericardial bioprosthesis. Method: Retrospective single-center study of consecutive pulmonary valve replacement in patients with pulmonary regurgitation following initial congenital cardiac surgery. From 2004 to 2016, 82 adult patients (53 males, 29 females) underwent pulmonary valve replacement at a mean age of 28.7 ± 8 years (range 18-52 years) with a mean time to pulmonary valve replacement of 24 ± 7 years (range 13-43 years). Porcine bioprosthetic valves (group 1, n = 32) and pericardial valves (group 2, n = 50) were used. Cardiac magnetic resonance imaging was performed (n = 54) at a mean of 18 ± 13 months before and 24 ± 21 months after pulmonary valve replacement. Results: No significant difference was seen between the groups except that the mean follow-up was longer for group 1 (5.02 ± 2.06 vs 4.08 ± 3.21 years). In-hospital mortality was 1.1%. Follow-up completeness was 100% with no late death. Mean right ventricular end-systolic and end-diastolic volumes reduced significantly in both the groups ( P < .001), whereas right ventricular ejection fraction remained unchanged (group 1, P = .129; group 2, P = .675) . Only the left ventricular end-diastolic volume increased in both the groups, but the increase was significant for group 2 only (group 1, P = .070; group 2, P = .015), whereas the left ventricular end-systolic and ejection fraction remained unchanged in both the groups. There was no reoperation for pulmonary valve replacement. Freedom from intervention was 93.8% (group 1) and 100% (group 2) at eight years after pulmonary valve replacement ( P = .407). Conclusion: Midterm outcomes of pulmonary valve replacement in our adult cohort were satisfactory. Both types of bioprosthetic valves performed comparably for eight years and were a good option in adults.

scholarly journals Mid- to long-term follow-up of pulmonary valve replacement with BioIntegral injectable valve

2020 ◽  
Author(s):  
Simone Ghiselli ◽  
Cristina Carro ◽  
Nicola Uricchio ◽  
Giuseppe Annoni ◽  
Stefano M Marianeschi
Keyword(s):  
Cardiopulmonary Bypass ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement

Abstract OBJECTIVES Chronic pulmonary valve (PV) regurgitation is a common late sequela after repair of congenital heart diseases like tetralogy of Fallot or pulmonary stenosis, leading to right ventricular dilatation and failure and increased late morbidity and mortality. Timely reoperation may lead to a complete right ventricular recovery. An injectable PV allows pulmonary valve replacement, with or without cardiopulmonary bypass, under direct observation, thereby minimizing the impact of surgery on cardiac function. The aim of this study was to evaluate the feasibility and mid- to long-term clinical outcomes with this device. METHODS From April 2007 to October 2019, a total of 85 symptomatic patients with severe pulmonary regurgitation or pulmonary stenosis underwent pulmonary valve replacement with an injectable stented pulmonary prosthesis. Data were collected from the international proctoring registry. Mean patient age was 26.7 years. The underlying diagnosis was repaired tetralogy of Fallot in 69.4% patients; moderate or severe pulmonary regurgitation was present in 72.9%. All patients had echocardiographic scans before the operation and during the follow-up period. A total of 54.1% patients also had preoperative/postoperative cardiac magnetic resonance imaging (MRI) or catheterization; 25.9% had off-pump implants. In 53% patients, pulmonary valve replacement was associated with the repair of other cardiac defects. RESULTS Minor postoperative complications were observed in 10.8% patients. The overall mortality rate was 2.3%; mortality after valve replacement was linked to a severe cardiac insufficiency and it was not related to a prosthesis failure; 1 prosthesis was explanted from 1 patient because of endocarditis, and 6% of patients developed PV stenosis; minor complications occurred in 4.8%. The mean follow-up period was 4.8 years (2 months–12.7 years); 42% of the patients were followed for more than 5 years. Follow-up echocardiography and cardiac MRI showed a significant reduction in RV size and low gradients across the PV. CONCLUSIONS An injectable PV may be implanted without cardiopulmonary bypass and in a hybrid operating theatre with minimal surgical impact. The bioprosthesis, available up to large sizes, has a low profile, laminar flow and no risk of coronary artery compression. Incidence of endocarditis is rare. The lack of a suture ring permits the implant of a relatively larger prosthesis, thereby avoiding a right ventricular outflow tract obstruction. This device permits future percutaneous valve-in-valve procedures, if needed. Results concerning durability are encouraging, and mid- to long-term haemodynamic performance is excellent.

scholarly journals Tissue Valve Replacement for Severe Calcified Pulmonary Stenosis: First time in BSMMU

2014 ◽  
Vol 9 (1) ◽  
pp. 54-55
Author(s):  
Rezwanul Haque Bulbul ◽  
Omar Sadeque Khan ◽  
Mohammad Samir Azam Sunny ◽  
Swadesh Ranjan Sarker ◽  
Mostafa Nuruzzaman
Keyword(s):  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Tissue Valve ◽  
Biventricular Failure ◽  
First Time

Pulmonary valve replacement for pulmonary regurgitation is a common practise. Pulmonary stenosis relief or after release of right ventricular outflow tract obstruction, progressive pulmonary regurgitation leading to biventricular failure is a big problem. If early pulmonary valve replacement done by homograft or tissue valve then we can overcome this problem. In our case report we have done pulmonary valve replacement by Edward life science Tissue valve for calcified pulmonary valve. And our patient showed a good response after valve replacement. DOI: http://dx.doi.org/10.3329/uhj.v9i1.19514 University Heart Journal Vol. 9, No. 1, January 2013; 54-55

Right Ventricular Function after Pulmonary Valve Replacement in Patients with Tetralogy of Fallot

Radiology ◽  
2004 ◽  
Vol 233 (3) ◽  
pp. 824-829 ◽  
Author(s):  
Alexander van Straten ◽  
Hubert W. Vliegen ◽  
Mark G. Hazekamp ◽  
Jeroen J. Bax ◽  
Paul H. Schoof ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Function ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Right Ventricular Function ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement
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