Is Repeated Pulmonary Valve Replacement a Safe and Effective Procedure?

Background: Lifetime procedural load in congenital heart disease is considerable and redo pulmonary valve replacement (PVR) is common. Our goal was to compare operative and postoperative outcomes in patients with first PVR vs. patients with multiple PVR.

Method: Retrospective review of 104 consecutive patients, who underwent PVR between January 2014 and March 2021. Fifty-three patients underwent their first PVR (Group 1). Fifty-one patients underwent second or more PVR (Group 2, 31 patients with 2 PVR, 20 patients with 3 and more PVR). The patients in group 1 were also preoperated at least one time. Intraoperative times, concomitant procedures, postoperative length of stay on ICU/intra hospital, intrahospital mortality, intraoperative and postoperative complications, postoperative peak gradient, and pulmonary valve insufficiency were compared.

Results: No significant differences in terms of age (Group 1 median age: 16.5 years [IQR: 12–25.4], Group 2 with median age 17.9 years [IQR: 14.9–29.1], p = 0.06) and concomitant procedures (p = 0.23). Group 2 had significant longer total operation time (394 vs. 265 min), total CBP time (209 vs. 135 min, and cross-clamp time (107 vs. 67 min, all p < 0.001) indicating greater surgical complexity in this patient group. Length of postoperative hospital stay was significantly enhanced in Group 2 (9 vs. 7 days, p = 0.02), without significant difference in length of stay on ICU (2 vs. 3 days) or number of complications (p = 0.11). No differences in postoperative peak pressure gradients with 9 (IQR: 5–13.7) vs. 9 (IQR: 6–13.5) mm Hg and postoperative pulmonary valve regurgitation with 0 (IQR: 0–1) vs. 0 (IQR: 0–1) (p > 0.05). There were no differences in hemodynamics and number of complications in patients who underwent third and more PVR (20 patients) vs. patients who underwent first or second PVR (84 patients). There were two deaths in Group 2, both in patients with endocarditis. In Group 1, there was one death due to preoperative biventricular heart failure (right and left ventricular ejection fraction less than 20%) and postoperative ECMO therapy.

Conclusion: The intraoperative time data represent the increasing complexity of repeated reoperations. Patients with multiple PVR needed longer hospitalization without significant difference in postoperative complications. Regardless, the functional results of the implants are excellent. Postoperative morbidity and mortality depend mainly on non-reoperative patient characteristics (endocarditis, poor LV function).

Publication History

Article published online:
28 January 2023