Independent factors associated with longevity of prosthetic pulmonary valves and valved conduits

Abstract

Objective: To evaluate the age dependence of variables predictive of pulmonary valve prosthesis replacement, we conducted the following analysis. Methods: Retrospective analysis of 945 operations in 726 patients, undergoing placement of pulmonary valve prostheses was performed. Age was identified as a strong independent predictor of valve failure. The database was stratified into age-based subsets and predictors of valve replacement were identified within each subset. Results: For the entire cohort, freedom from valve replacement at 5 years was 81%. Younger age was strongly associated with decreased time to valve replacement by multivariable analysis (hazard ratio: 0.71/log-year, P < .001). Other independent factors included diagnosis, type of prosthesis, and time-dependent requirement for pulmonary valve stent placement. Important predictors of valve failure varied among age groups and are as follows: for age less than 3 months: valve type; for age 3 months to less than 2 years: smaller normalized valve prosthesis size; for age 2 years to less than 13 years: sex, smaller normalized valve prosthesis size, placement of endovascular stents, and valve type; for age 13 years to 65 years: smaller normalized valve prosthesis size, placement of endovascular stents, and increased number of previous valve placements. Conclusion: Age is a dominant risk factor predictive of pulmonary valve prosthesis failure. A significant interaction exists between age and the effects of diagnosis, valve type, and size on prosthetic pulmonary valve longevity.