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

OBJECTIVES: Pulmonary valve regurgitation is a common problem after relief of right ventricular outflow tract obstruction with a transannular patch (TAP). Pulmonary valve replacement (PVR) with a homograft or xenograft is the routine treatment. Longevity of biological valves and availability of homografts is limited and alternatives to restore RVOT competence are evaluated. This study presents 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 analyzed perioperative data, pre- and postoperative cardiac magnetic resonance (CMR) imaging studies, freedom from valve replacement and risk factors for pulmonary valve dysfunction.

RESULTS: Underlying diagnosis was tetralogy of Fallot (n = 18, 75%), pulmonary stenosis (n = 5, 20.8%) and double outlet right ventricle post banding procedure (n = 1, 4.2%). Median age was 21.5 (14.8 - 23.7) years. Main (n = 9, 37.5%) and branch pulmonary artery procedures (n = 6, 25%) as well as surgery of the RVOT (n = 16, 30.2%) were often part of the reconstruction. Median follow-up after surgery was 8.0 (4.7 - 9.7) years. Freedom from valve failure was 96% at two and 90% at five years. The mean longevity of the reconstructive surgery was 9.9 years (95% confidence interval: 8.8 - 11.1 years). CMR before and six months after surgery showed a reduction in regurgitation fraction (41% (33-55) vs. 20% (18-27) p = 0.001) and of indexed right ventricular enddiastolic volume (156ml/m2 (149-175) vs. 116ml/m2 (100-143) p = 0.004). Peak velocity across the pulmonary valve (CMR) half a year after surgery was 2.0 unchanged.

CONCLUSIONS: PVr can be achieved with acceptable intermediate-term results and may delay PVR.