title: One hundred pulmonary valve replacements in children after relief of right ventricular outflow tract obstruction.
abstract: BACKGROUND
  Surgical repair of obstructive lesions of the right ventricular outflow tract (RVOT) in children commonly creates pulmonary valve incompetence that may eventually require pulmonary valve replacement (PVR). We reviewed our experience with PVR late after RVOT reconstruction.
  
  
  METHODS
  We performed 100 PVRs in 93 children 1.1 months to 22.4 years (median 8) after RVOT reconstruction. Children with right ventricular to pulmonary artery conduits and primary PVRs were excluded. Age at PVR was 4.5 months to 27.9 years (median 9.5 years). Initial diagnosis was tetralogy of Fallot and variants, 62; critical pulmonary stenosis, 15; pulmonary atresia with intact ventricular septum, 7; and others, 9. Eleven patients had a redo PVR. A total of 62 PVRs were homografts; 38 were porcine valves.
  
  
  RESULTS
  There was one early death. On follow-up of 5 months to 12.4 years (mean 4.9 years) there were no late deaths although 1 child underwent cardiac transplantation. Actuarial freedom from redo PVR at 8 years was 100% for porcine valves but 70% for homograft valves (p = 0.17). For children younger than 3 years at PVR, freedom from reoperation was 76% at 1 year and 39% at 8 years compared with freedom from redo PVR at 8 years of 100% for children older than 3 years. On latest echocardiogram 97% of porcine valves had mild or no pulmonary regurgitation compared with 72% of homograft valves.
  
  
  CONCLUSIONS
  PVR after RVOT reconstruction can be performed with low risk. Porcine valves may be superior to homograft valves although this advantage may be due to older age at time of PVR.
authors.affiliation: Department of Surgery, and the Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia 30322, USA. kkanter@emory.edu
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Kanter
authors.forename: Jason M
authors.initials: JM
authors.lastname: Budde
authors.forename: W James
authors.initials: WJ
authors.lastname: Parks
authors.forename: Vincent K H
authors.initials: VK
authors.lastname: Tam
authors.forename: Shiva
authors.initials: S
authors.lastname: Sharma
authors.forename: Willis H
authors.initials: WH
authors.lastname: Williams
authors.forename: Derek A
authors.initials: DA
authors.lastname: Fyfe
mesh_terms: D000293:Adolescent; D000328:Adult; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011664:Pulmonary Valve; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D014694:Ventricular Outflow Obstruction / Q000601:surgery*