Mechanical valves in the pulmonary position: An international retrospective analysis

Hanna Pragt, Joost P. van Melle, Hoda Javadikasgari, Dong Man Seo, John M. Stulak, Igor Knez, Jürgen Hörer, Christian Muñoz-Guijosa, Mahyar G. Dehaki, Hong Ju Shin, Joseph A. Dearani, Maziar G. Dehaki, Petronella G. Pieper, Christine Eulenburg, Laura Dos, Tjark Ebels

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: Life expectancy of patients with congenital heart disease has improved over the past decades, increasing the need for a durable pulmonary prosthetic valve. Biological valves in various forms have become the valve of choice for pulmonary valve replacement (PVR), but structural valve deterioration is unavoidable in the long term. Use of a mechanical valve could be an alternative, but data on long-term outcomes are sparse. Methods: We retrospectively collected and analyzed data on 364 patients with mechanical valves implanted in the pulmonary position between 1965 and 2014. The data originate from medical centers in Barcelona (Spain), Graz (Austria), Groningen (the Netherlands), Munich (Germany), Rochester (United States), Seoul (Republic of Korea), and Tehran (Iran). Results: Median follow-up duration was 4.26 years (range, 0-27 years), mean age at implantation was 27.16 ± 12.2 years. Tetralogy of Fallot was the most common primary cardiac diagnosis, with a subgroup of 69.8%. Freedom from valvular thrombosis was 91% (95% confidence interval [CI], 87%-94%) at 5 years and 86% (95% CI, 81%-91%) at 10 years post-PVR. With a success rate up to 88%, thrombolysis was a successful therapy. Freedom from reoperation was 97% (95% CI, 94%-99%) at 5 years post-PVR and 91% (95% CI, 85%-95%) at 10 years. Conclusions: Mechanical PVR is associated with a limited risk of valvular thrombosis. Thrombolysis was an effective treatment in the majority.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - 2017

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Pulmonary Valve
Confidence Intervals
Thrombosis
Republic of Korea
Tetralogy of Fallot
Austria
Iran
Life Expectancy
Reoperation
Netherlands
Spain
Germany
Heart Diseases
Lung
Therapeutics

Keywords

  • Congenital heart disease
  • Mechanical heart valve pulmonary valve replacement

ASJC Scopus subject areas

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

Cite this

Pragt, H., van Melle, J. P., Javadikasgari, H., Seo, D. M., Stulak, J. M., Knez, I., ... Ebels, T. (Accepted/In press). Mechanical valves in the pulmonary position: An international retrospective analysis. Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2017.04.072

Mechanical valves in the pulmonary position : An international retrospective analysis. / Pragt, Hanna; van Melle, Joost P.; Javadikasgari, Hoda; Seo, Dong Man; Stulak, John M.; Knez, Igor; Hörer, Jürgen; Muñoz-Guijosa, Christian; Dehaki, Mahyar G.; Shin, Hong Ju; Dearani, Joseph A.; Dehaki, Maziar G.; Pieper, Petronella G.; Eulenburg, Christine; Dos, Laura; Ebels, Tjark.

In: Journal of Thoracic and Cardiovascular Surgery, 2017.

Research output: Contribution to journalArticle

Pragt, H, van Melle, JP, Javadikasgari, H, Seo, DM, Stulak, JM, Knez, I, Hörer, J, Muñoz-Guijosa, C, Dehaki, MG, Shin, HJ, Dearani, JA, Dehaki, MG, Pieper, PG, Eulenburg, C, Dos, L & Ebels, T 2017, 'Mechanical valves in the pulmonary position: An international retrospective analysis', Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2017.04.072
Pragt, Hanna ; van Melle, Joost P. ; Javadikasgari, Hoda ; Seo, Dong Man ; Stulak, John M. ; Knez, Igor ; Hörer, Jürgen ; Muñoz-Guijosa, Christian ; Dehaki, Mahyar G. ; Shin, Hong Ju ; Dearani, Joseph A. ; Dehaki, Maziar G. ; Pieper, Petronella G. ; Eulenburg, Christine ; Dos, Laura ; Ebels, Tjark. / Mechanical valves in the pulmonary position : An international retrospective analysis. In: Journal of Thoracic and Cardiovascular Surgery. 2017.
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abstract = "Objective: Life expectancy of patients with congenital heart disease has improved over the past decades, increasing the need for a durable pulmonary prosthetic valve. Biological valves in various forms have become the valve of choice for pulmonary valve replacement (PVR), but structural valve deterioration is unavoidable in the long term. Use of a mechanical valve could be an alternative, but data on long-term outcomes are sparse. Methods: We retrospectively collected and analyzed data on 364 patients with mechanical valves implanted in the pulmonary position between 1965 and 2014. The data originate from medical centers in Barcelona (Spain), Graz (Austria), Groningen (the Netherlands), Munich (Germany), Rochester (United States), Seoul (Republic of Korea), and Tehran (Iran). Results: Median follow-up duration was 4.26 years (range, 0-27 years), mean age at implantation was 27.16 ± 12.2 years. Tetralogy of Fallot was the most common primary cardiac diagnosis, with a subgroup of 69.8{\%}. Freedom from valvular thrombosis was 91{\%} (95{\%} confidence interval [CI], 87{\%}-94{\%}) at 5 years and 86{\%} (95{\%} CI, 81{\%}-91{\%}) at 10 years post-PVR. With a success rate up to 88{\%}, thrombolysis was a successful therapy. Freedom from reoperation was 97{\%} (95{\%} CI, 94{\%}-99{\%}) at 5 years post-PVR and 91{\%} (95{\%} CI, 85{\%}-95{\%}) at 10 years. Conclusions: Mechanical PVR is associated with a limited risk of valvular thrombosis. Thrombolysis was an effective treatment in the majority.",
keywords = "Congenital heart disease, Mechanical heart valve pulmonary valve replacement",
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T2 - An international retrospective analysis

AU - Pragt, Hanna

AU - van Melle, Joost P.

AU - Javadikasgari, Hoda

AU - Seo, Dong Man

AU - Stulak, John M.

AU - Knez, Igor

AU - Hörer, Jürgen

AU - Muñoz-Guijosa, Christian

AU - Dehaki, Mahyar G.

AU - Shin, Hong Ju

AU - Dearani, Joseph A.

AU - Dehaki, Maziar G.

AU - Pieper, Petronella G.

AU - Eulenburg, Christine

AU - Dos, Laura

AU - Ebels, Tjark

PY - 2017

Y1 - 2017

N2 - Objective: Life expectancy of patients with congenital heart disease has improved over the past decades, increasing the need for a durable pulmonary prosthetic valve. Biological valves in various forms have become the valve of choice for pulmonary valve replacement (PVR), but structural valve deterioration is unavoidable in the long term. Use of a mechanical valve could be an alternative, but data on long-term outcomes are sparse. Methods: We retrospectively collected and analyzed data on 364 patients with mechanical valves implanted in the pulmonary position between 1965 and 2014. The data originate from medical centers in Barcelona (Spain), Graz (Austria), Groningen (the Netherlands), Munich (Germany), Rochester (United States), Seoul (Republic of Korea), and Tehran (Iran). Results: Median follow-up duration was 4.26 years (range, 0-27 years), mean age at implantation was 27.16 ± 12.2 years. Tetralogy of Fallot was the most common primary cardiac diagnosis, with a subgroup of 69.8%. Freedom from valvular thrombosis was 91% (95% confidence interval [CI], 87%-94%) at 5 years and 86% (95% CI, 81%-91%) at 10 years post-PVR. With a success rate up to 88%, thrombolysis was a successful therapy. Freedom from reoperation was 97% (95% CI, 94%-99%) at 5 years post-PVR and 91% (95% CI, 85%-95%) at 10 years. Conclusions: Mechanical PVR is associated with a limited risk of valvular thrombosis. Thrombolysis was an effective treatment in the majority.

AB - Objective: Life expectancy of patients with congenital heart disease has improved over the past decades, increasing the need for a durable pulmonary prosthetic valve. Biological valves in various forms have become the valve of choice for pulmonary valve replacement (PVR), but structural valve deterioration is unavoidable in the long term. Use of a mechanical valve could be an alternative, but data on long-term outcomes are sparse. Methods: We retrospectively collected and analyzed data on 364 patients with mechanical valves implanted in the pulmonary position between 1965 and 2014. The data originate from medical centers in Barcelona (Spain), Graz (Austria), Groningen (the Netherlands), Munich (Germany), Rochester (United States), Seoul (Republic of Korea), and Tehran (Iran). Results: Median follow-up duration was 4.26 years (range, 0-27 years), mean age at implantation was 27.16 ± 12.2 years. Tetralogy of Fallot was the most common primary cardiac diagnosis, with a subgroup of 69.8%. Freedom from valvular thrombosis was 91% (95% confidence interval [CI], 87%-94%) at 5 years and 86% (95% CI, 81%-91%) at 10 years post-PVR. With a success rate up to 88%, thrombolysis was a successful therapy. Freedom from reoperation was 97% (95% CI, 94%-99%) at 5 years post-PVR and 91% (95% CI, 85%-95%) at 10 years. Conclusions: Mechanical PVR is associated with a limited risk of valvular thrombosis. Thrombolysis was an effective treatment in the majority.

KW - Congenital heart disease

KW - Mechanical heart valve pulmonary valve replacement

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