Pulmonary valve replacement: a comparison of three biological valves.
BACKGROUND
We retrospectively reviewed the performance of the mosaic porcine, bovine pericardial, and homograft prostheses for pulmonary valve replacement to correct chronic pulmonary insufficiency.


METHODS
From January 1995 to August 2006, 82 patients (mean age, 22.7 years) underwent valve replacement with porcine (49 patients), bovine pericardial (18 patients), or pulmonary homograft (15 patients) prosthesis at a mean of 15.3 years after initial outflow tract reconstruction. Excluded were patients with extracardiac conduits, monocusp valves, or the Ross procedure. The groups were similar with respect to age, body surface area, degree of regurgitation, right ventricular dimension, right ventricular to pulmonary artery gradient, and valve size. Follow-up was longer in the homograft cohort (porcine, 20 +/- 27 months; pericardial, 42 +/- 21; homograft, 49 +/- 40; p < 0.01).


RESULTS
All three prostheses significantly reduce chronic pulmonary regurgitation, but late insufficiency was higher with homografts. Right ventricular dimension was significantly reduced in the stented but not the allograft cohorts. Late valve dysfunction was highest with homografts (54%), followed by porcine (19%) and pericardial valves (5.5%; p < 0.05. Functional class and mild to moderate tricuspid insufficiency significantly improved with pulmonary valve replacement. Early and late mortality was 3.6% and 1.2%, respectively.


CONCLUSIONS
All three prostheses performed similarly for 3 years. Pulmonary regurgitation developed more frequently in homografts albeit at a longer duration of follow-up.
Fiore
Andrew C
AC
Division of Cardiothoracic Surgery, St. Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, Missouri 63104, USA. fiorem2@slu.edu
Rodefeld
Mark
M
Turrentine
Mark
M
Vijay
Palaniswamy
P
Reynolds
Tyler
T
Standeven
John
J
Hill
Kirstin
K
Bost
Jamie
J
Carpenter
Dustin
D
Tobin
Courtney
C
Brown
John W
JW
D000293:Adolescent; D000328:Adult; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011665:Pulmonary Valve Insufficiency / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation