Outcomes of redo pulmonary valve replacement for bioprosthetic pulmonary valve failure in 61 patients with congenital heart disease

Abstract

OBJECTIVES: Although all bioprostheses used for pulmonary valve (PV) replacement (PVR) are prone to failure and will require redo PVR, data pertaining to the outcomes of this procedure are lacking. The objective of this study was to evaluate outcomes of redo PVR for bioprosthetic PV failure in patients with congenital heart disease. METHODS: A retrospective review of 61 patients who underwent redo PVR for bioprosthetic PV failure between November 1999 and June 2013 was performed. Univariable analyses were used to identify the factors associated with postoperative adverse events (PAEs). RESULTS: The median age at initial PVR was 7.0 years (1.6-36.5 years) and the median age at redo PVR was 13.5 years (7.6-43.3 years). Fundamental diagnoses were tetralogy of Fallot (n = 20), pulmonary atresia with ventricular septal defect (n = 20), double outlet right ventricle (n = 7) and others (n = 14). The median valve size was 25 mm (18-28 mm). There were 2 hospital deaths (3.3%). Eighteen patients (29.5%) experienced PAEs. PAEs were associated with higher preoperative right ventricular systolic pressure (105 ± 22 vs 89 ± 19 mmHg, P = 0.016) and longer cardiopulmonary bypass time (219 ± 77 vs 164 ± 59 min, P = 0.007). Completeness of follow-up was 98.3% and the median duration of follow-up was 5.5 years (0.1-14.3 years). There were 3 late deaths. The actuarial survival rate at 10 years was 83.7 ± 8.0%. Eleven patients underwent the second redo PVR during follow-up. The rate of freedom from the second redo PVR at 10 years was 58.8 ± 11.9%. The rate of freedom from both PV reintervention and structural valve deterioration (SVD) at 10 years was 32.0 ± 13.3%. CONCLUSIONS: A substantial number of the patients experienced mortality or morbidities after redo PVR. Higher preoperative right ventricular systolic pressure and longer cardiopulmonary bypass time were associated with PAEs. By 10 years after the redo PVR, approximately two-thirds of patients will require PV reintervention or manifest SVD.