Ann Thorac Surg. 2023 Sep 2:S0003-4975(23)00919-0. doi: 10.1016/j.athoracsur.2023.08.019. Online ahead of print.
BACKGROUND: In 2016, we reported promising mid-term outcomes of the bicuspid pulmonary valve replacement using 0.1-mm polytetrafluoroethylene (PTFE) membrane. This follow-up study analyzes long-term outcomes and risk factors for reintervention and structural valve deterioration (SVD).
METHODS: We performed a retrospective review of the original 119 patients who underwent PTFE bicuspid pulmonary valve replacement. The median age was 16.9 years (range 0.4 to 57.1 years). Reintervention was defined as any surgical or percutaneous catheter procedure on the PTFE valve. SVD was defined as development of a peak pressure gradient ≥ 50 mmHg or ≥ moderate amount of pulmonary regurgitation on follow-up echocardiography.
RESULTS: The median follow-up duration was 9.5 years. The survival rate was 96.5% at 5 and 10 years, with 2 early and 2 late mortalities. Freedom from reintervention was 90.0% at 5 years and 63.3% at 10 years. Freedom from SVD was 92.8% at 5 years and 51.1% at 10 years, with regurgitation being the predominant mode (64.6%). Freedom from both reintervention and SVD at 5 and 10 years were 89.1% and 49.5%, respectively. Multivariable analysis identified smaller valve diameter (hazard ratio 0.82, p<0.001) and more than trivial pulmonary regurgitation at discharge (hazard ratio 5.81, p<0.001) as risk factors for reintervention or SVD.
CONCLUSIONS: Long-term results of the PTFE bicuspid PVR were acceptable. However, improvements may be needed to reduce technical error and improve durability. Smaller valve diameter and more than trivial pulmonary regurgitation at discharge were risk factors for reintervention or SVD, warranting careful follow-up for timely reintervention.