Mechanical valves in the pulmonary position: an international retrospective analysis

Abstract Objective Life expectancy of patients with congenital heart disease has improved over the past decades, increasing the need for a durable pulmonary prosthetic valve. Biological valves in various forms have become the valve of choice for pulmonary valve replacement (PVR), but structural valve deterioration is unavoidable in the long term. Use of a mechanical valve could be an alternative, but data on long-term outcome is sparse. Methods We retrospectively collected and analyzed data on 364 patients with mechanical valves implanted in the pulmonary position between 1965 and 2014. The data originates from medical centers in Barcelona (Spain), Graz (Austria), Groningen (the Netherlands), Munich (Germany), Rochester (USA), Seoul (Republic of Korea), and Tehran (Iran). Results Median follow-up duration was 4.26 (range 0-27) years, mean age at implantation was 27.16 ± (SD 12.2) years. Tetralogy of Fallot was the most common primary cardiac diagnosis with a subgroup of 69.8%. Freedom from valvar thrombosis was 91% (95%CI 87%-94%) at 5 years and 86% (95% CI 81%-91%) at 10 years post PVR. With a success rate up to 88%, thrombolysis was a successful therapy. Freedom from reoperation was 97% (95% CI 94%-99%) at 5 years post PVR and 91% (95%CI 85%-95%) at 10 years. Conclusion MPVR is associated with a limited risk of valvar thrombosis. Thrombolysis was an effective treatment in the majority.