Surgical and percutaneous pulmonary valve replacement in England over the past two decades

Abstract

ObjectivePulmonary valve replacement (PVR) is often required in patients with congenital heart disease. We aimed to describe temporal trends in PVR in a nationwide English cohort between 1997 and 2014, survival and the need for re-PVR.MethodsPatients were identified in the Hospital Episode Statistics Database. Survival data were retrieved from the UK Office for National Statistics.ResultsA total of 2733 patients underwent PVR (2845 procedures) over the study period. Median age at first procedure increased from 20.1 years in 1997–2005 to 24.7 years in 2006–2014. The annual number of PVRs increased from 23 in 1997 to 251 in 2014. Homografts were the most common choice in the early years, but the use of xenografts increased after 2005. During a median follow-up of 5.8 years, 176 patients died and 108 required redo PVR. Early (30 day) survival was 98% for all PVRs and was similar for all types of prostheses but longer-term mortality dropped to 92% at 10 years and 90% at 15 years. Age >16 years and percutaneous PVR were risk factors for death. The cumulative incidence for re-PVR at 10 years was 8% for all PVRs and 11% at 15 years. Risk factors for re-PVR were complex diagnosis, male gender and black ethnicity.ConclusionThere was a significant increase in the number of PVRs performed in England over the last two decades and a significant change in the type of prosthesis employed. While early mortality was low across the board, longer-term mortality was not negligible in this young population.

Changes in the Cath Lab in the Treatment of Adult Patients with Congenital Heart Disease: A 12-Year Experience in a Single Referral Center with the Establishment of a Dedicated Working Group

“…Also, the number of PPVI procedures increased in the second period, but this was the result not only of the institution of the ACHD Unit, but also of the availability of new devices for treatment of the native outflow tract, as described in the literature [ 22 ]. In fact, new devices like the new self-expanding pulmonary valves are increasing the indications for percutaneous procedures even for large outflow tracts, until now reserved to cardiac surgery.…”

Percutaneous Transcatheter Valve-in-Valve Pulmonary and Tricuspid Replacement in Carcinoid Heart Disease

“…These manifestations include tricuspid and pulmonary stenosis/regurgitation and right heart dilatation and failure, necessitating valve replacements. The high burden of metastasis may be associated with early bioprosthetic failure due to circulating vasoactive substances requiring high-risk reoperation ( 1 , 2 ). Transcatheter SAPIEN valves (Edwards, Irvine, California) in inferior and superior vena cava for tricuspid regurgitation and transventricular Melody® valves (Medtronic, Minneapolis, Minnesota) in the right ventricular outflow tract for pulmonary stenosis/regurgitation have been used to avoid repeat sternotomy ( 3 , 4 , 5 , 6 ).…”

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

“…According to UK data, reoperation was needed in 8% at 10 years and in 11% at 15 years among 2,733 patients undergoing pulmonary valve replacement. 698 Timely replacement of the pulmonary valve will off-load the RV, and the RV parameters change favorably. 694,695,699-701 NYHA class improves, 694,702 but better exercise tolerance may not be proven objectively.…”