Long-Term Outcome of Mechanical Pulmonary Valve Replacement in 121 Patients with Congenital Heart Disease

Abstract

Background A tissue valve is the prosthesis of choice in the majority of children and adults requiring pulmonary valve replacement (PVR). Mechanical valves, on the other hand, are more durable but require anticoagulation therapy and carry the elevated risk of thrombosis. The aim of this study was to investigate the long-term outcomes of mechanical prosthetic valves in a single referral tertiary center.

Patients and Methods Recorded data of 121 patients who underwent mechanical PVR between April 2003 and April 2013 at our center were reviewed, retrospectively. Eighty-four patients (69.4%) were male and their mean age was 23.12 ± 7.86 years. Tetralogy of Fallot was the most common diagnosis (n = 109). Complete follow-up was performed for all patients (mean 7.02 ± 1.90 years).

Results Nobody died and no significant bleeding event was detected during follow-up. Mechanical valve malfunction happened in 10 patients (8.3%) while in 1 of them malfunction happened because of pannus formation and in the remaining 9 because of thrombosis. Just one of the thrombotic events could not be treated with streptokinase and required reoperation. Freedom from reoperation rates were 100, 99, and 98% at 1, 5, and 10 years, respectively; freedom from valve thrombosis event rates were 100, 93, and 91% at 1, 5, and 10 years, respectively; and freedom from bleeding event rates was 98% at 1, 5, and 10 years.

Conclusion Mechanical prosthetic valves demonstrated excellent durability and a low risk of valve thrombosis at the pulmonary position when patients are adequately anticoagulated.

Keywords

pulmonary valve replacement - mechanical valve - congenital heart disease

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