Risk factors for prosthesis failure in pulmonary valve replacement.
BACKGROUND
After initial right ventricular outflow tract reconstruction, replacement of the pulmonary valve (PVR) with a bioprosthetic valve may be performed. Bioprosthetic valves fail (PVF) and require repeat replacement. Identification of risk factors for PVF would be useful for clinicians choosing among various options for the initial PVR.


METHODS
We retrospectively analyzed outcomes of 169 consecutive patients (55% male) with repaired tetralogy of Fallot or pulmonary stenosis undergoing a first PVR. Data were abstracted from the medical records, including gender, diagnosis, indication for PVR, age at PVR (< 10 years or ≥ 10 years), type of valve, and time of PVF. Actuarial freedom from PVF was compared by log rank and parametric survival analysis. Risk factors for PVF were analyzed by univariate and multivariate methods. Prosthesis types for PVR were pulmonary homograft in 56, stented porcine valve in 16, stented porcine valve in Dacron (DuPont, Wilmington, DE) conduit in 26, and bovine pericardial valve in 71.


RESULTS
Indication for PVR was pulmonary stenosis in 21% and insufficiency in 79%. Median follow-up for the entire cohort was 8 years. PVF occurred in 24 patients at a median time of 5.7 years. Actuarial freedom from PVF at 10 years was 72% for all valve types, 55% for porcine valve in Dacron conduit, 60% for homograft, 75% for porcine valve, and 78% for bovine pericardial valve (p = 0.36). By univariate analysis, young age (p < 0.0001), male gender (p = 0.0017), and indication of pulmonary stenosis (p = 0.015) were risk factors for PVF. In multivariate analysis, tetralogy of Fallot anatomy (p < 0.06), younger age (p < 0.02), and use of a homograft valve (p < 0.02) were risk factors for early PVF (<3 years). Young age (p < 0.0001) at time of PVR was associated with late PVF.


CONCLUSIONS
Freedom from reoperation for PVR during 10 years of follow-up is excellent. Younger age, tetralogy of Fallot, and use of a homograft valve were risk factors for early PVF. Only younger age at PVR was a significant risk factor for late PVF.
Division of Pediatric Cardiology, University of Arkansas for the Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas 72202, USA. rzubairi@gmail.com
Rahel
R
Zubairi
Sadia
S
Malik
Robert D B
RD
Jaquiss
Michiaki
M
Imamura
Jeff
J
Gossett
W Robert
WR
Morrow
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000818:Animals; D001705:Bioprosthesis; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000453:epidemiology / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D013552:Swine; D013771:Tetralogy of Fallot / Q000453:epidemiology; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000453:epidemiology / Q000601:surgery; D055815:Young Adult