Document Detail

The increasing use of mechanical pulmonary valve replacement over a 40-year period.
MedLine Citation:
PMID:  21095354     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Because reoperation is often necessary for bioprostheses, mechanical pulmonary valve replacement (mPVR) may be appropriate for many patients. Mechanical prostheses are durable, but there has been concern concerning valve thrombosis and bleeding complications from warfarin.
METHODS: Between October 1965 and August 2008, 54 patients (33 male, median age 30 years, range 5 to 66) underwent mechanical PVR at our institution (40 patients since 2004). Forty-nine of these 54 patients underwent a total of 110 prior operations (median 2, maximum 5), including 89 prior operations on the right ventricular outflow tract (median 1, maximum 4). Diagnoses included congenital (n = 47) and carcinoid (n = 7) heart disease. Bleeding complications were compared with a 1:2 matched patient cohort (age, gender, and diagnosis) receiving bioprosthetic PVR.
RESULTS: The most common concomitant procedures were tricuspid valve replacement in 15 patients, aortic root replacement in 14, and aortic valve replacement in 13. At last follow-up in 45 of 51 early survivors (median 2.2 years, maximum 20 years), there was no perivalvular leak, vegetations, pannus formation, or valve thrombosis. Further, no patient required reoperation on mPVR. Major late bleeding complications occurred in 3 of 54 patients in the mPVR group and 4 of 108 in the tissue PVR group.
CONCLUSIONS: Thromboembolic complications are rare with therapeutic international normalized ratios and mechanical PVR provides excellent durability and freedom from reoperation. Tissue PVR does not eliminate bleeding complications. Mechanical PVR should be considered in select patients with multiple prior operations, or when there is another need for warfarin anticoagulation.
John M Stulak; Joseph A Dearani; Harold M Burkhart; Heidi M Connolly; Carole A Warnes; Rakesh M Suri; Hartzell V Schaff
Related Documents :
3277554 - Heart valve replacement with the björk-shiley monostrut valve: early results of a mult...
11419894 - Aortic stenosis with severe left ventricular dysfunction and low transvalvular pressure...
96684 - Structural changes in glutaraldehyde-treated porcine heterografts used as substitute ca...
16545654 - Treatment of calcific aortic stenosis with the percutaneous heart valve: mid-term follo...
23788194 - Association of perioperative troponin and atrial fibrillation after coronary artery byp...
23840204 - Bicarbonates for the prevention of postoperative renal failure in endovascular aortic a...
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  90     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  2009-14; discussion 2014-5     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Child, Preschool
Follow-Up Studies
Heart Valve Diseases / surgery*
Heart Valve Prosthesis / utilization*
Middle Aged
Prosthesis Design
Prosthesis Failure
Pulmonary Valve / surgery*
Reoperation / utilization*
Retrospective Studies
Thromboembolism / etiology,  prevention & control*
Time Factors
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Hypothermic circulatory arrest increases permeability of the blood brain barrier in watershed areas.
Next Document:  Reoperation after supravalvular aortic stenosis repair.