Polytetrafluoroethylene Bicuspid Pulmonary Valve Replacement: A 5-Year Experience in 119 Patients With Congenital Heart Disease

Abstract

Durability of bioprosthetic valves in the pulmonary position is suboptimal. The objective of this study was to evaluate midterm outcomes of hand-sewn polytetrafluoroethylene (PTFE) bicuspid pulmonary valve replacement. A retrospective review of 119 patients who underwent bicuspid pulmonary valve replacement using 0.1-mm PTFE membrane between June 2009 and May 2014 was performed. Reintervention was defined as any surgical or percutaneous catheter procedure on the PTFE pulmonary valve. Structural valve deterioration (SVD) was defined as development of a peak pressure gradient equal to or greater than 50 mm Hg or at least a moderate amount of pulmonary regurgitation on follow-up echocardiography. The median age at pulmonary valve replacement was 16.9 years (range 5 months to 57.1 years). Fundamental diagnoses were tetralogy of Fallot (n= 71), pulmonary atresia with ventricular septal defect (n= 21), double-outlet right ventricle (n= 13), and others (n=14). The median valve size was 26 mm (range 12 to 30 mm). Two hospital deaths (1.7%) occurred, from ventricular dysfunction and infective endocarditis. At discharge, no patient showed significant pulmonary regurgitation or stenosis. Follow-up completeness was 94.0%, and the median duration of follow-up was 2.6 years (range 0.1 to 5.2 years). One late death occurred, the result of infective endocarditis involving the PTFE pulmonary valve. Actuarial survival was 97.1% ± 1.6% at 5 years. One patient underwent excision of the PTFE pulmonary valve because of infective endocarditis. Freedom from pulmonary valve reoperation was 99.1% ± 0.9% at 5 years. Ten patients developed SVD during follow-up, and 6 of them underwent an interventional catheter procedure. Freedom from pulmonary valve reintervention and SVD at 5 years was 90.7% ± 3.4% and 86.5% ± 4.0%, respectively. Midterm outcomes of hand-sewn PTFE bicuspid pulmonary valve replacement were acceptable. Long-term follow-up of this cohort is mandatory to determine the durability of this valve.