title: Pulmonary valve replacement: twenty-six years of experience with mechanical valvar prostheses.
abstract: BACKGROUND
  Although the thromboembolic risk after pulmonary valve replacement (PVR) with mechanical valves is presumed to be high, recent studies suggest promising short-term and mid-term results. However, large studies reporting long-term mortality and valve-related complications are missing.
  
  
  METHODS
  We describe valve-related complications in 66 patients with a mechanical pulmonary valvar prosthesis implanted between 1987 and 2013.
  
  
  RESULTS
  Mean follow-up duration was 5.9 ± 4.8 years (median 4.9). Mean age at time of implantation was 35 ± 13 years. The most frequent underlying cardiac diagnosis was tetralogy of Fallot (77%). Valvar thrombosis or pannus was reported in 7 patients (10%) of which 4 in the setting of inadequate anticoagulation or pregnancy. Redo PVR was performed in 6 patients. Freedom from redo PVR in survivors after 5 and 10 years was 96% and 89%, respectively. Survival after 5 and 10 years was 91% and 81%, respectively. Main cause of death was end-stage heart failure.
  
  
  CONCLUSIONS
  Success of PVR using mechanical valvar prostheses over 26 years was limited because of valvar thrombosis (often in the setting of pregnancy or incompliance with anticoagulation therapy) or pannus. Performance of mechanical prostheses in the pulmonary position may improve when valvar thrombosis is prevented by patient selection, avoiding mechanical valves in patients at increased risk of valvar thrombosis, and by strict compliance to anticoagulation therapy.
authors.affiliation: Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
authors.forename: Hendrik G
authors.initials: HG
authors.lastname: Freling
authors.affiliation: Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands; Department of Thoracic Surgery, University Medical Center Groningen, Groningen, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
authors.forename: Ymkje J
authors.initials: YJ
authors.lastname: van Slooten
authors.affiliation: Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.affiliation: Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Thoracic Surgery, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Tjark
authors.initials: T
authors.lastname: Ebels
authors.affiliation: Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Elke S
authors.initials: ES
authors.lastname: Hoendermis
authors.affiliation: Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Pediatric Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Rolf M F
authors.initials: RM
authors.lastname: Berger
authors.affiliation: Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.affiliation: Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Thoracic Surgery, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Tjalling W
authors.initials: TW
authors.lastname: Waterbolk
authors.affiliation: Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Tineke P
authors.initials: TP
authors.lastname: Willems
authors.affiliation: Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands; Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: p.g.pieper@umcg.nl.
authors.forename: Petronella G
authors.initials: PG
authors.lastname: Pieper
mesh_terms: D000328:Adult; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors