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Durability of Pulmonary Valve Replacement with Large Diameter Stented Porcine Bioprostheses

      There is limited information about durability of large diameter porcine bioprostheses implanted for pulmonary valve replacement (PVR). We studied patients who underwent surgical PVR from 2002-2019 with a stented porcine bioprosthetic valve (BPV) with a labeled size ≥27 mm. The primary outcome was freedom from reintervention. During the study period, 203 patients underwent PVR using a porcine BPV ≥27 mm, 94% of whom received a Mosaic valve (Medtronic Inc., Minneapolis, MN). Twenty patients underwent reintervention from 3.4-12.0 years after PVR: 5 surgical and 15 transcatheter PVR procedures. The indication for reintervention was regurgitation in 13 patients, stenosis in 2, mixed disease in 4, and endocarditis in 1. Estimated freedom from reintervention was 97±1% at 5 years and 82±4% at 10 years, and freedom from prosthesis dysfunction (moderate or severe regurgitation and/or a maximum Doppler gradient ≥50 mm Hg) over time was 91±2% at 5 years and 74±4% at 10 years. Younger age and smaller true valve diameter were associated with shorter freedom from reintervention, but valve oversizing was not. The durability of large stented porcine bioprostheses in the pulmonary position is generally excellent, particularly in adolescents and adults, similar to various other types of BPV. In the current study, relative valve size was not associated with valve longevity, although the low event-rate in this population was a limiting factor.

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      Linked Article

      • Commentary: Upsizing the Potential Performance of Pulmonary Valve Prostheses
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
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          Dr Maeda and colleagues from Stanford University present excellent outcomes from their institutional practice of using large stented porcine bioprosthetic valves (ie, ≥27 mm diameter) for pulmonary valve replacement surgeries in pediatric and adult patients (PVR).1 Their large patient population from over a long 17-year study period included a mean age range of 10–49 years, though over 60% of patients were 18 years or older. Patient follow-up was very complete with a modest median interval of 6.5 years.
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