Issues about pulmonary valve replacement: retrospective single center analysis with 9 years of follow-up data / 中华胸心血管外科杂志

ABSTRACT

Objective To study the pulmonary valve replacement(PVR) operation indications and timing,the choice of prosthetic valve,and the anticoagulation methods.Methods Between June 2006 and April 2017,10 patients(median age 22.5 years,range 10 to 46) underwent PVR at our hospital.These issues above were discussed by analysing data from the patients and literature review.Results The 10 patients were all diagnosed with congenital heart disease(CHD),6 with CHD and infective endocarditis and 4 with postoperation of complex CHD like tetralogy of Fallot or pulmonary artery atresia.Five patients had prior cardiac operations.Bioprosthesis valve was implanted in 2 cases,while mechanical valve in 8.The international normalized ratio(INR) was maintained between 1.8 and 2.5 for patients with mechanical valve.There was one in-hospital death,and the other 9 patients were all followed up.The median follow-up was 65 months(range,3-110 months).During follow-up,there was no death,and reoperation was undertaken in one patient who had ceased anticoagulation for 2 years with a mechanical valve,and bioprosthesis valve was chosed in reoperation,Except of this patient,no valve thrombus or severe bleeding complication happened.All prosthetic valves demonstrated normal function by cardiac color ultrasound.The mean peak transvalvular pressure gradient for the mechanical valves was 12.0 mmHg(range,8.7-14.0 mmHg),while for the bioprosthesis valves was 24.7 mmHg(1 mmHg =0.133 kPa) (range,22-27 mmHg) (P ＜ 0.01).Overall actuarial survival at 7 years for patients receiving bioprosthesis valve PVR was 100％,while for mechanical valve was 85 ％ (P =0.617);Overall actuarial freedom from reoperation at 7 years for patients receiving bioprosthesis valve PVR was 100％,while for mechanical valve was 71％ (P =0.414).The findings of literature review were as followsthe risk of valve thrombus or severe bleeding complication for mechanical pulmonary valve was not higher than bioprosthesis pulmonary valve under standard anticoagulant therapy;the durability of bioprosthesis pulmonary valves was unsatisfactory,while the medium and long term effects of mechanical valves were good;the hemodynamic properties of mechanical pulmonary valve were better than bioprosthesis pulmonary valve;the lowintensity anticoagulation method was safe and effective for Chinese people.Conclusion PVR is a safe and effective treatment for patients with severe pulmonary valve regurgitation or stenosis,and the medium and long term effects of mechanical valve are satisfactory.PVR is recommended as early as meeting the operation indications.The choice of a prosthetic valve should be careful and individual.At present,the bioprosthesis valves are implanted in pulmonery valve position more than mechanical valves.However,in select patients and by standard anticoagulant therapy,mechanical pulmonry valves will bring better benefit.The low-intensity anticoagulation method(INR 1.8-2.5) is safe and effective,and recommened for Chinese people.