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.
Keywords
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Publication history
Published online: May 07, 2021
Footnotes
Funding: No funding was received for this study.
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- Commentary: Upsizing the Potential Performance of Pulmonary Valve ProsthesesSeminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
- PreviewDr 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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