Assessment of the longevity of valves placed in the pulmonary position in patients with congenital heart disease

Pulmonary valve replacement is often performed in patients with complex congenital heart disease with pathology involving the right ventricular outflow tract. Progressive valve dysfunction is a well-described phenomenon. The aim of this study was to compare the longevity of homograft and bioprosthetic valves placed in the pulmonary position and to determine factors influencing valve dysfunction. We conducted a retrospective chart review of all patients who underwent surgical pulmonary valve replacement with homograft or bioprosthetic (bovine pericardial or porcine) valves during the period January 2000 through December 2013 (n = 81). Serial echocardiographic data and the time to valve dysfunction were reviewed as well as factors associated with valve dysfunction and/or re-intervention. There was a shorter time to valve dysfunction in the homograft valve group as compared to the bioprosthetic valve group. Freedom from valve dysfunction was 63% at 1 year, 38% at 5 years and 29% at 10 years in the homograft group compared to 96% at 1 year, 77% at 5 years and 52% at 10 years in the bioprosthetic valve group. However, on subgroup analysis, age at surgery was strongly associated with time to valve dysfunction, with older age being more protective (chi square with one degree of freedom = 23.42; p ≤ 0.0001; hazard ratio 0.857). When adjusted for age, there was no significant difference in freedom from valve dysfunction between the two valve types (chi square with one degree of freedom = 0.031; p = 0.86). Overall, the longevity of bioprosthetic valve and homograft valve used in right ventricular outflow surgery is largely dependent on the age of valve implantation with no difference in valve performance between valve types.