Pulmonary valve reconstruction for acquired pulmonary regurgitation in patients with treated congenital heart disease.
CMR evaluation
Congenital heart surgery
Pulmonary valve reconstruction
Journal
Interdisciplinary cardiovascular and thoracic surgery
ISSN: 2753-670X
Titre abrégé: Interdiscip Cardiovasc Thorac Surg
Pays: England
ID NLM: 9918540787006676
Informations de publication
Date de publication:
04 Oct 2023
04 Oct 2023
Historique:
received:
18
01
2023
revised:
09
04
2023
accepted:
20
06
2023
medline:
21
6
2023
pubmed:
21
6
2023
entrez:
21
6
2023
Statut:
ppublish
Résumé
Pulmonary valve regurgitation is a common problem after relief of right ventricular outflow tract (RVOT) obstruction with a transannular patch. Pulmonary valve replacement with a homograft or xenograft is the routine treatment. Longevity of biological valves and the availability of homografts are limited. Alternatives to restore RVOT competence are evaluated. The goal of this study was to present intermediate-term results for pulmonary valve reconstruction (PVr) in patients with severe regurgitation. PVr was performed in 24 patients (August 2006‒July 2018). We analysed perioperative data, pre- and postoperative cardiac magnetic resonance (CMR) imaging studies, freedom from valve replacement and risk factors for pulmonary valve dysfunction. The underlying diagnoses were tetralogy of Fallot (n = 18, 75%), pulmonary stenosis (n = 5, 20.8%) and the double outlet right ventricle post banding procedure (n = 1, 4.2%). The median age was 21.5 (14.8-23.7) years. Main (n = 9, 37.5%) and branch pulmonary artery procedures (n = 6, 25%) and surgery of the RVOT (n = 16, 30.2%) were often part of the reconstruction. The median follow-up after the operation was 8.0 (4.7-9.7) years. Freedom from valve failure was 96% at 2 and 90% at 5 years. The mean longevity of the reconstructive surgery was 9.9 years (95% confidence interval: 8.8-11.1 years). CMR before and 6 months after surgery showed a reduction in the regurgitation fraction [41% (33-55) vs 20% (18-27) P = 0.00] and of the indexed right ventricular end-diastolic volume [156 ml/m2 (149-175) vs 116 ml/m2 (100-143), P = 0.004]. Peak velocity across the pulmonary valve (determined by CMR) half a year after surgery was 2.0, unchanged. PVr can be achieved with acceptable intermediate-term results and may delay pulmonary valve replacement.
Identifiants
pubmed: 37341633
pii: 7204427
doi: 10.1093/icvts/ivad105
pmc: PMC10581336
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
Références
Cell Tissue Bank. 2022 Jun;23(2):347-366
pubmed: 34453660
Eur J Cardiothorac Surg. 2019 Feb 7;:
pubmed: 30753373
Heart. 2015 Nov;101(21):1717-23
pubmed: 26175476
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2006;:11-22
pubmed: 16638542
J Thorac Cardiovasc Surg. 2021 Nov;162(5):1324-1333.e3
pubmed: 33640135
World J Pediatr Congenit Heart Surg. 2013 Oct;4(4):422-6
pubmed: 24327638
Circulation. 2002 Sep 24;106(13):1703-7
pubmed: 12270866
Ann Thorac Surg. 2012 Sep;94(3):850-2
pubmed: 22717301
Expert Rev Cardiovasc Ther. 2007 Mar;5(2):221-30
pubmed: 17338667
Eur J Cardiothorac Surg. 2008 Nov;34(5):1041-5
pubmed: 18760931
Eur Heart J. 2010 Dec;31(23):2915-57
pubmed: 20801927
Eur J Cardiothorac Surg. 2001 May;19(5):667-70
pubmed: 11343950
J Thorac Cardiovasc Surg. 2022 Sep;164(3):752-762.e8
pubmed: 35058063
Eur J Cardiothorac Surg. 2020 Feb 1;57(2):380-387
pubmed: 31302680
Biopreserv Biobank. 2017 Apr;15(2):148-157
pubmed: 28151005
Eur J Cardiothorac Surg. 2021 Jan 4;59(1):162-169
pubmed: 32864698
Circulation. 2017 Oct 31;136(18):1703-1713
pubmed: 29084778
J Thorac Cardiovasc Surg. 2018 Aug;156(2):728-734.e2
pubmed: 29753513