title: The Midterm Outcomes of Bioprosthetic Pulmonary Valve Replacement in Children.
abstract: The purpose of this study was to assess the outcomes of bioprosthetic pulmonary valve replacement (PVR) in children. This is a retrospective review of all bioprosthetic PVR in children (≤ 20-year old) between 1992 and 2013 at a single institution. Most outcomes studied included pulmonary valve reintervention and bioprosthetic valve function. A total of 136 bioprosthetic PVRs were identified for 123 patients. The median age and body weight at the time of operation were 13.2 years and 48.4 kg. There were 1 early death and 3 late deaths during the median follow-up of 7.2 years (0-22.0 years). The actuarial transplant-free survival was 97.6% at 10 years. There were 43 bioprosthesis reinterventions with 29 reoperations and 14 catheter-based interventions. The freedom from bioprosthesis reintervention was 89.6% and 55.0% at 5 and 10 years, respectively. Echocardiographic bioprosthesis dysfunction (≥ moderate bioprosthesis insufficiency, ≥ 50 mmHg peak gradient through bioprosthesis, or bioprosthesis endocarditis with vegetation) was found in 57 bioprostheses. The freedom from bioprosthesis dysfunction was 74.0% and 32.8% at 5 and 10 years, respectively. Results from the Cox proportional hazards models showed that age had significant association with freedom from bioprosthesis reintervention and freedom from bioprosthesis dysfunction (P < 0.001 and P = 0.03), whereas bioprosthesis type had nonsignificant association with freedom from bioprosthesis dysfunction (P = 0.068). Bioprosthetic PVR in children had excellent early outcomes but rapidly deteriorating midterm outcomes. Careful and close follow-up are necessary for children with bioprosthesis in the pulmonary position.
authors.affiliation: Division of Pediatric and Congenital Cardiothoracic Surgery, Arkansas Children׳s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: TShinkawa@uams.edu.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shinkawa
authors.affiliation: Division of Pediatric and Congenital Cardiothoracic Surgery, Arkansas Children׳s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Chiajung K
authors.initials: CK
authors.lastname: Lu
authors.affiliation: Division of Pediatric and Congenital Cardiothoracic Surgery, Arkansas Children׳s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Carl
authors.initials: C
authors.lastname: Chipman
authors.affiliation: Biostatistics Program, Department of Pediatrics, Arkansas Children׳s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
authors.affiliation: Biostatistics Program, Department of Pediatrics, Arkansas Children׳s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Gossett
authors.affiliation: Division of Pediatric and Congenital Cardiothoracic Surgery, Arkansas Children׳s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
mesh_terms: D000293:Adolescent; D001131:Arkansas / Q000453:epidemiology; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
keywords: CHD; congenital heart disease; pediatric; pulmonary valve