Surgical pulmonary valve replacement: a benchmark for outcomes comparisons.
BACKGROUND
Patients with right heart obstructive lesions develop residual or recurrent right ventricle outflow tract pathology as a result of native or implanted pulmonary valve (PV) dysfunction. Until recently, the standard of care has been surgical placement of a PV or valved right ventricle to pulmonary artery conduit. Catheter-based options are being increasingly applied in patients with PV dysfunction. The purpose of our study was to evaluate outcomes of surgical pulmonary valve/conduit replacement (PVR) at a large pediatric hospital to provide contemporary benchmark data for comparison with developing technologies.


METHODS
Retrospective review of patients undergoing PVR not associated with complex concomitant procedures from July 1995 to December 2010 was completed. Inclusion criteria were designed to generally match those applied to patients promoted for catheter-based valve replacement based on age and weight (age≥5 years and weight≥30 kg).


RESULTS
There were 148 PVRs with all patients having undergone ≥1 previous interventions (tetralogy of Fallot [53%] and pulmonary atresia [17%]). Surgical indications were PV insufficiency (60%), PV stenosis (26%), and both (13%). Valves used included bioprosthetic (n=108; 73%) and homografts (n=40; 27%). Time-to-extubation, intensive care unit stay, and hospital length of stay were <1 day (interquartile range, 0-1 day), 2 days (interquartile range, 1-2 days), and 5 days (interquartile range, 4-6 days), respectively, with no hospital deaths. Freedom from PV reintervention at 1, 3, and 5 years was 99%, 99%, and 94%, respectively. Multivariable analysis showed age<13 years (P=.003), and smaller valve size (P=.025) were associated with increased risk of valve reintervention. Patient survival at follow-up (mean, 5.0±3.9 years) was 99%.


CONCLUSIONS
Surgical PVR is safe with low in-hospital and midterm follow-up mortality and reoperation rates. These outcomes provide a useful benchmark for treatment strategy comparisons.
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex. Electronic address: edmckenz@texaschildrens.org.
E Dean
ED
McKenzie
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex.
Muhammad S
MS
Khan
Department of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex.
Thomas W
TW
Dietzman
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex.
Francisco A
FA
Guzmán-Pruneda
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex.
Andres X
AX
Samayoa
Department of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex.
Aimee
A
Liou
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex.
Jeffrey S
JS
Heinle
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex.
Charles D
CD
Fraser
D000293:Adolescent; D002648:Child; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000209:etiology / Q000601:surgery*