The increasing use of mechanical pulmonary valve replacement over a 40-year period

John M. Stulak, Joseph A. Dearani, Harold M. Burkhart, Heidi M. Connolly, Carole A. Warnes, Rakesh M. Suri, Hartzell V Schaff

Research output: Contribution to journalArticle

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Abstract

Background Because reoperation is often necessary for bioprostheses, mechanical pulmonary valve replacement (mPVR) may be appropriate for many patients. Mechanical prostheses are durable, but there has been concern concerning valve thrombosis and bleeding complications from warfarin. Methods Between October 1965 and August 2008, 54 patients (33 male, median age 30 years, range 5 to 66) underwent mechanical PVR at our institution (40 patients since 2004). Forty-nine of these 54 patients underwent a total of 110 prior operations (median 2, maximum 5), including 89 prior operations on the right ventricular outflow tract (median 1, maximum 4). Diagnoses included congenital (n = 47) and carcinoid (n = 7) heart disease. Bleeding complications were compared with a 1:2 matched patient cohort (age, gender, and diagnosis) receiving bioprosthetic PVR. Results The most common concomitant procedures were tricuspid valve replacement in 15 patients, aortic root replacement in 14, and aortic valve replacement in 13. At last follow-up in 45 of 51 early survivors (median 2.2 years, maximum 20 years), there was no perivalvular leak, vegetations, pannus formation, or valve thrombosis. Further, no patient required reoperation on mPVR. Major late bleeding complications occurred in 3 of 54 patients in the mPVR group and 4 of 108 in the tissue PVR group. Conclusions Thromboembolic complications are rare with therapeutic international normalized ratios and mechanical PVR provides excellent durability and freedom from reoperation. Tissue PVR does not eliminate bleeding complications. Mechanical PVR should be considered in select patients with multiple prior operations, or when there is another need for warfarin anticoagulation.

Original languageEnglish (US)
Pages (from-to)2009-2014
Number of pages6
JournalAnnals of Thoracic Surgery
Volume90
Issue number6
DOIs
StatePublished - Dec 2010

Fingerprint

Pulmonary Valve
Reoperation
Hemorrhage
Warfarin
Thrombosis
Bioprosthesis
Tricuspid Valve
International Normalized Ratio
Carcinoid Tumor
Aortic Valve
Prostheses and Implants
Survivors
Heart Diseases

ASJC Scopus subject areas

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

Cite this

Stulak, J. M., Dearani, J. A., Burkhart, H. M., Connolly, H. M., Warnes, C. A., Suri, R. M., & Schaff, H. V. (2010). The increasing use of mechanical pulmonary valve replacement over a 40-year period. Annals of Thoracic Surgery, 90(6), 2009-2014. https://doi.org/10.1016/j.athoracsur.2010.07.023

The increasing use of mechanical pulmonary valve replacement over a 40-year period. / Stulak, John M.; Dearani, Joseph A.; Burkhart, Harold M.; Connolly, Heidi M.; Warnes, Carole A.; Suri, Rakesh M.; Schaff, Hartzell V.

In: Annals of Thoracic Surgery, Vol. 90, No. 6, 12.2010, p. 2009-2014.

Research output: Contribution to journalArticle

Stulak, JM, Dearani, JA, Burkhart, HM, Connolly, HM, Warnes, CA, Suri, RM & Schaff, HV 2010, 'The increasing use of mechanical pulmonary valve replacement over a 40-year period', Annals of Thoracic Surgery, vol. 90, no. 6, pp. 2009-2014. https://doi.org/10.1016/j.athoracsur.2010.07.023
Stulak JM, Dearani JA, Burkhart HM, Connolly HM, Warnes CA, Suri RM et al. The increasing use of mechanical pulmonary valve replacement over a 40-year period. Annals of Thoracic Surgery. 2010 Dec;90(6):2009-2014. https://doi.org/10.1016/j.athoracsur.2010.07.023
Stulak, John M. ; Dearani, Joseph A. ; Burkhart, Harold M. ; Connolly, Heidi M. ; Warnes, Carole A. ; Suri, Rakesh M. ; Schaff, Hartzell V. / The increasing use of mechanical pulmonary valve replacement over a 40-year period. In: Annals of Thoracic Surgery. 2010 ; Vol. 90, No. 6. pp. 2009-2014.
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AU - Warnes, Carole A.

AU - Suri, Rakesh M.

AU - Schaff, Hartzell V

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N2 - Background Because reoperation is often necessary for bioprostheses, mechanical pulmonary valve replacement (mPVR) may be appropriate for many patients. Mechanical prostheses are durable, but there has been concern concerning valve thrombosis and bleeding complications from warfarin. Methods Between October 1965 and August 2008, 54 patients (33 male, median age 30 years, range 5 to 66) underwent mechanical PVR at our institution (40 patients since 2004). Forty-nine of these 54 patients underwent a total of 110 prior operations (median 2, maximum 5), including 89 prior operations on the right ventricular outflow tract (median 1, maximum 4). Diagnoses included congenital (n = 47) and carcinoid (n = 7) heart disease. Bleeding complications were compared with a 1:2 matched patient cohort (age, gender, and diagnosis) receiving bioprosthetic PVR. Results The most common concomitant procedures were tricuspid valve replacement in 15 patients, aortic root replacement in 14, and aortic valve replacement in 13. At last follow-up in 45 of 51 early survivors (median 2.2 years, maximum 20 years), there was no perivalvular leak, vegetations, pannus formation, or valve thrombosis. Further, no patient required reoperation on mPVR. Major late bleeding complications occurred in 3 of 54 patients in the mPVR group and 4 of 108 in the tissue PVR group. Conclusions Thromboembolic complications are rare with therapeutic international normalized ratios and mechanical PVR provides excellent durability and freedom from reoperation. Tissue PVR does not eliminate bleeding complications. Mechanical PVR should be considered in select patients with multiple prior operations, or when there is another need for warfarin anticoagulation.

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