Excellent Durability and Bothersome Events after Mechanical Pulmonary Valve Replacement

Han ki Park, Yu Rim Shin, Young-Hwan Park

Yonsei University Health System, Seoul, Korea (South)

Date, time and location: 2018.05.26 17:00, Congress Hall, 2F–B

Abstract

Objective

A mechanical prosthesis plays a role in pulmonary valve replacement (PVR) to avoid multiple reoperations. However, thromboembolic risk and bleeding complications are major drawbacks for mechanical pulmonary valve replacement. The aim of this study is to investigate outcomes of mechanical prosthetic valves in a single center.

Methods

We reviewed medical records of 46 patients who underwent mechanical PVR between January 2005 and December 2015. Thirty-seven (80%) patients were male and the mean age was 26.0± 1.6 years. Indications for PVR were severe pulmonary valve regurgitation in 28 patients, pulmonary valve stenosis in 1 patient, and combined pathology in 7 patients. Mean follow-up duration was 8.6± 0.5 years.

Results

There was no long-term death. Right ventricular volume reduced significantly after PVR (right ventricular end-diastolic volume index, 173±35 vs. 111±18 ml/m², p < 0.01). Prosthetic valve malfunction occurred in three patients because of valve thrombosis in two patients despite adequate anticoagulation and because of pannus formation in the remaining patient. Redo PVR was performed in 2 patients. Freedom from reoperation or re-intervention was 98%, 95%, and 87% at 5, 7, and 10 years, respectively. Major bleeding events occurred in 12 patients, and three of them required multiple admissions to control their anticoagulation. Freedom from bleeding events was 81%, 86%, and 69% at 5, 7, and 10 years, respectively

Conclusions

Pulmonary valve replacement using mechanical prosthesis may be a reasonable solution to avoid multiple reoperations with low risk of pannus formation or thrombosis. However, rates of bleeding complications were higher than previously reported. Therefore, mechanical pulmonary valve replacement should be performed in highly selected patients.