Pulmonary valve reconstruction for acquired pulmonary regurgitation in patients with treated congenital heart disease

Jill Jussli-Melchers; Jan Hinnerk Hansen; Jens Scheewe; Tim Attmann; Martin Eide; Jana Logoteta; Peter Dütschke; Mona Salehi Ravesh; Anselm Uebing; Inga Voges

doi:10.1093/icvts/ivad105

Pulmonary valve reconstruction for acquired pulmonary regurgitation in patients with treated congenital heart disease

Interdiscip Cardiovasc Thorac Surg. 2023 Oct 4;37(4):ivad105. doi: 10.1093/icvts/ivad105.

Authors

Affiliations

¹ Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
² Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.
³ Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany.
⁴ Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany.
⁵ DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany.

Abstract

Objectives: Pulmonary valve regurgitation is a common problem after relief of right ventricular outflow tract (RVOT) obstruction with a transannular patch. Pulmonary valve replacement with a homograft or xenograft is the routine treatment. Longevity of biological valves and the availability of homografts are limited. Alternatives to restore RVOT competence are evaluated. The goal of this study was to present intermediate-term results for pulmonary valve reconstruction (PVr) in patients with severe regurgitation.

Methods: PVr was performed in 24 patients (August 2006‒July 2018). We analysed perioperative data, pre- and postoperative cardiac magnetic resonance (CMR) imaging studies, freedom from valve replacement and risk factors for pulmonary valve dysfunction.

Results: The underlying diagnoses were tetralogy of Fallot (n = 18, 75%), pulmonary stenosis (n = 5, 20.8%) and the double outlet right ventricle post banding procedure (n = 1, 4.2%). The median age was 21.5 (14.8-23.7) years. Main (n = 9, 37.5%) and branch pulmonary artery procedures (n = 6, 25%) and surgery of the RVOT (n = 16, 30.2%) were often part of the reconstruction. The median follow-up after the operation was 8.0 (4.7-9.7) years. Freedom from valve failure was 96% at 2 and 90% at 5 years. The mean longevity of the reconstructive surgery was 9.9 years (95% confidence interval: 8.8-11.1 years). CMR before and 6 months after surgery showed a reduction in the regurgitation fraction [41% (33-55) vs 20% (18-27) P = 0.00] and of the indexed right ventricular end-diastolic volume [156 ml/m2 (149-175) vs 116 ml/m2 (100-143), P = 0.004]. Peak velocity across the pulmonary valve (determined by CMR) half a year after surgery was 2.0, unchanged.

Conclusions: PVr can be achieved with acceptable intermediate-term results and may delay pulmonary valve replacement.

Keywords: CMR evaluation; Congenital heart surgery; Pulmonary valve reconstruction.