title: Influence of pulmonic position on durability of bioprosthetic heart valves.
abstract: BACKGROUND
  The insertion of bioprosthetic valves into the pulmonic position is not performed commonly because of uncertainty concerning the necessity and durability of such valves.
  
  
  METHODS
  We reviewed the long-term outcome of 10 patients who underwent pulmonary valve replacement with bioprostheses between March 1985 and March 1997. A Carpentier-Edwards supraannular bioprosthesis was used in 7 patients, a Hancock II bioprosthesis was used in 2 patients, and a Carpentier-Edwards pericardial bioprosthesis was used in 1 patient. The mean patient age at the time of pulmonary valve replacement was 38.9 +/- 16.3 years (range, 15 to 63 years). The diagnoses were pulmonary valvular regurgitation after corrective surgery for tetralogy of Fallot in 7 patients, right ventricular outflow tract stenosis and absent right pulmonary artery combined with a double-outlet right ventricle in 1 patient, pulmonary valvular regurgitation with pulmonary artery dilatation in 1 patient, and aortic valve stenosis treated with our modification of the Ross procedure using a pulmonary bioprosthesis in 1 patient. Survivors were followed up for a mean of 5 years and 5 months.
  
  
  RESULTS
  One patient underwent reoperation because of infective endocarditis of the bioprosthesis. No bioprosthetic valve dysfunction has been observed on Doppler echocardiography during a maximum follow-up period of 12.2 years, except in the patient who underwent replacement at 15 years of age.
  
  
  CONCLUSIONS
  Bioprostheses in the pulmonic position are durable in adult patients because they face a minimal hemodynamic load, but they may undergo early leaflet degeneration in younger patients.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Fukada
authors.forename: K
authors.initials: K
authors.lastname: Morishita
authors.forename: K
authors.initials: K
authors.lastname: Komatsu
authors.forename: T
authors.initials: T
authors.lastname: Abe
mesh_terms: D000293:Adolescent; D000328:Adult; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities; D011664:Pulmonary Valve; D011665:Pulmonary Valve Insufficiency / Q000601:surgery; D012086:Reoperation; D013771:Tetralogy of Fallot / Q000601:surgery; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000601:surgery