title: Outcome and performance of bioprosthetic pulmonary valve replacement in patients with congenital heart disease.
abstract: The goal of this single-center series was to assess differences in reintervention by the type of valve used for surgical bioprosthetic pulmonary valve replacement and to identify independent predictors of reintervention.
  
  
  
  Data were retrospectively collected for 611 patients undergoing pulmonary valve replacement from 1996 to 2014. Kaplan-Meier estimation and Cox proportional hazards regression methodologies were used.
  
  
  
  The median age of patients was 17.8 years (interquartile range, 11.9-27.3). The diagnosis was tetralogy of Fallot in 69% of patients. The median follow-up was 3.0 years (interquartile range, 1.1-5.3). Valve types included Sorin Mitroflow (Milan, Italy), 316 (50%; median age 16.5 years); Carpentier-Edwards (Irvine, Calif) Magna/MagnaEase, 223 (35%; median age, 19.3 years); and Carpentier-Edwards Perimount, 72 (11%; median age, 21.9 years). Reintervention occurred in 6.7% of patients (41/633) and was higher in children than adults (hazard ratio, 4.8). Age-adjusted 5-year reintervention rates were Sorin Mitroflow, 13.4%; Carpentier-Edwards Magna/MagnaEase, 2.1%; and Carpentier-Edwards Perimount, 0%. Reintervention was not associated with gender, valve insertion method, or concurrent procedures. The only independent risk factor for reintervention after controlling for age was valve type (P < .001). The Sorin Mitroflow valve had a shorter time to reintervention than the other 2 valve types (hazard ratios both >7, each P < .001). Differences by valve type did not depend on age (interaction P = .61).
  
  
  
  Bioprosthetic pulmonary valve replacement in patients with congenital heart disease has excellent short-term outcomes, but children have an approximately 5-fold greater risk of reintervention than adults. Independently of age, reintervention rates vary by valve type. These differences may be important in valve selection and follow-up.
authors.affiliation: Tufts Medical School, Boston, Mass; Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Rio
authors.initials: R
authors.lastname: Nomoto
authors.affiliation: Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Sleeper
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Michele J
authors.initials: MJ
authors.lastname: Borisuk
authors.affiliation: Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergerson
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Sitaram
authors.initials: S
authors.lastname: Emani
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Del Nido
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass. Electronic address: bairdc1@gmail.com.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baird
mesh_terms: D000293:Adolescent; D000328:Adult; D001705:Bioprosthesis; D002648:Child; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011664:Pulmonary Valve / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: bioprosthetic; congenital; pulmonary valve; replacement