title: Bioprosthetic pulmonary valve replacement: contemporary analysis of a large, single-center series of 170 cases.
abstract: OBJECTIVE
  The present study was designed to compare stented porcine and bovine pericardial valves used for pulmonary valve replacement to better define valve performance and postoperative quality of life.
  
  
  METHODS
  A retrospective review of all patients who underwent pulmonary valve replacement with a stented bioprosthesis from 1992 to 2008 was conducted. The medical records, imaging results, and quality of life questionnaires were analyzed. Differences in reintervention by valve type were determined using Cox proportional hazards models, controlling for subject age.
  
  
  RESULTS
  A total of 170 consecutive pulmonary valve replacements (73 stented porcine, group 1; 97 bovine pericardial, group 2) were reviewed. No significant differences were seen in patient age or implanted valve size between the groups. Surgical mortality was 1.2%. The median follow-up was 48.2 months and was longer for group 2. No significant difference was seen in the risk of reintervention by valve type (hazard ratio, 0.64; 95% confidence interval, 0.18-2.34; P = .51). After 39 months of follow-up, pulmonary stenosis and pulmonary insufficiency that was moderate or worse were more common in patients who had undergone pulmonary valve replacement at younger than 15 years (pulmonary stenosis, 30.9% vs 10.0%, P = .003; pulmonary insufficiency, 46.2% vs 3.8%, P < .001), regardless of valve type. All patients performed well mentally and physically on the quality of life surveys.
  
  
  CONCLUSIONS
  The present large series of stented bioprosthetic pulmonary valve replacements has demonstrated good results, particularly in adults, at intermediate follow-up. Freedom from reintervention was similar for the porcine and pericardial valves, and our finding did not clearly demonstrate the superiority of 1 type of valve. However, the stented bioprosthetic valves were less durable in younger patients.
authors.affiliation: Department of Cardiothoracic Surgery, Shanghai Tongji Hospital, Tongji University, Shanghai, China; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Xu-Jun
authors.initials: XJ
authors.lastname: Chen
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
authors.forename: James
authors.initials: J
authors.lastname: Jaggers
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lodge
mesh_terms: D000367:Age Factors; D001705:Bioprosthesis; D018572:Disease-Free Survival; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D053208:Kaplan-Meier Estimate; D009657:North Carolina; D010496:Pericardium / Q000637:transplantation*; D011183:Postoperative Complications / Q000601:surgery; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000601:surgery*; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: 26.1; 29; 35; PI; PS; PVR; RV; TOF; pulmonary insufficiency; pulmonary stenosis; pulmonary valve replacement; right ventricular; tetralogy of Fallot