title: Pulmonary valve replacement: a comparison of three biological valves.
abstract: 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.
authors.affiliation: Division of Cardiothoracic Surgery, St. Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, Missouri 63104, USA. fiorem2@slu.edu
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Fiore
authors.forename: Mark
authors.initials: M
authors.lastname: Rodefeld
authors.forename: Mark
authors.initials: M
authors.lastname: Turrentine
authors.forename: Palaniswamy
authors.initials: P
authors.lastname: Vijay
authors.forename: Tyler
authors.initials: T
authors.lastname: Reynolds
authors.forename: John
authors.initials: J
authors.lastname: Standeven
authors.forename: Kirstin
authors.initials: K
authors.lastname: Hill
authors.forename: Jamie
authors.initials: J
authors.lastname: Bost
authors.forename: Dustin
authors.initials: D
authors.lastname: Carpenter
authors.forename: Courtney
authors.initials: C
authors.lastname: Tobin
authors.forename: John W
authors.initials: JW
authors.lastname: Brown
mesh_terms: 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