title: Pulmonary valve replacement with a bovine pericardial valve: a five year follow-up study.
abstract: OBJECTIVE
  From a population of 90 patients after pulmonary valve replacement with a biological valve (Carpentier-Edwards Perimount valve), 56 of 80 available patients were examined five years after surgery.
  
  
  BACKGROUND
  Pulmonary valve replacement is needed in many patients with congenital heart disease. Homografts have limited availability and predictable degeneration, and mechanical valves require anticoagulation. No superiority of one kind of pulmonary valve replacement has been shown. Biological valves that are readily available are being used and evaluated in increasing numbers.
  
  
  METHODS
  In this cross-sectional study, five years following surgery, data were gathered from hospital charts, echocardiography, stress echocardiography, magnetic resonance imaging, and exercise testing.
  
  
  RESULTS
  In 90 patients, there were three new valve replacements, one early cardiac death, and four late noncardiac deaths. Echocardiographic assessment of the study group showed pulmonary Doppler velocities (m/s) before, after operation, and at five-year follow-up of 2.8±1.1, 1.6±0.4, and 2.3±0.7, respectively. The assessed insufficiencies (0-3) at the same times were 2.3±1.0, 0.3±0.4, and 1.1±0.8. Maximal oxygen uptake increased from 65.6%±10.1% to 77.1%±18.2% of predicted and QRS width increased by 7±23 ms. Valve degeneration could be associated with young age but not with diagnosis or valve size.
  
  
  CONCLUSIONS
  In our study, the biological valve in the pulmonary position showed excellent mid-term results with few reoperations, low gradients, and mild to moderate insufficiency. Oversizing, in contrast to young age, was not a risk factor for valve degeneration. In younger patients, this allows later percutaneous replacement, reducing the need for further surgery. However, longer follow-up is needed.
authors.affiliation: Section for Paediatric Heart Diseases, Rikshospitalet, Oslo University Hospital, Norway cneukamm@ous-hf.no.
authors.forename: Christian
authors.initials: C
authors.lastname: Neukamm
authors.affiliation: Section for Congenital Cardiac Surgery, Rikshospitalet, Oslo University Hospital, Norway.
authors.forename: Harald L
authors.initials: HL
authors.lastname: Lindberg
authors.affiliation: Paediatric Unit, Division of Diagnostics and Intervention, Rikshospitalet, Oslo University Hospital, Norway.
authors.forename: Kirsti
authors.initials: K
authors.lastname: Try
authors.affiliation: Section for Paediatric Heart Diseases, Rikshospitalet, Oslo University Hospital, Norway.
authors.forename: Gaute
authors.initials: G
authors.lastname: Døhlen
authors.affiliation: Section for Paediatric Heart Diseases, Rikshospitalet, Oslo University Hospital, Norway.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Norgård
mesh_terms: D000293:Adolescent; D000328:Adult; D001705:Bioprosthesis; D002648:Child; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D011664:Pulmonary Valve / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: adult congenital heart disease; bioprosthesis; congenital heart surgery; echocardiography; heart valve; magnetic resonance imaging (MRI); pulmonary valve; statistics; survival analysis