Open AccessLong‐Term Comparison Between Pulmonary Homograft Versus Bioprosthesis for Pulmonary Valve Replacement in Tetralogy of Fallot
Author(s) -
Cocomello Lucia,
Meloni Marco,
Rapetto Filippo,
Baquedano Mai,
Ordoñez Maria Victoria,
Biglino Giovanni,
BucciarelliDucci Chiara,
Parry Andrew,
Stoica Serban,
Caputo Massimo
Publication year - 2019
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.119.013654
Subject(s) - interquartile range , medicine , tetralogy of fallot , cardiology , pulmonary valve , pulmonary valve insufficiency , heart transplantation , surgery , pulmonary artery , transplantation , pulmonary regurgitation , heart disease
Background Tetralogy of Fallot repair results in late occurrence of pulmonary regurgitation, which requires pulmonary valve replacement in a large proportion of patients. Both homografts and bioprostheses are used for pulmonary valve replacement as uncertainty remains on which prosthesis should be considered superior. We performed a long‐term imaging and clinical comparison between these 2 strategies. Methods and Results We compared echocardiographic and clinical follow‐up data of 209 patients with previous tetralogy of Fallot repair who underwent pulmonary valve replacement with homograft (n=75) or bioprosthesis (n=134) between 1995 and 2018 at a tertiary hospital. The primary end point was the composite of pulmonary valve replacement reintervention and structural valve deterioration, defined as a transpulmonary pressure decrease ≥50 mm Hg or pulmonary regurgitation degree of ≥2. Mixed linear model and Cox regression model were used for comparisons. Echocardiographic follow‐up duration was longer in the homograft group (8 [interquartile range, 4–12] versus 4 [interquartile range, 3–6] years; P <0.001). At the latest echocardiographic follow‐up, homografts showed a significantly lower transpulmonary systolic pressure decrease (16 [interquartile range, 12–25] mm Hg) when compared with bioprostheses (28 [interquartile range, 18–41] mm Hg; mixed model P <0.001) and a similar degree of pulmonary regurgitation (degree 0‐4) (1 [interquartile range, 0–2] versus 2 [interquartile range, 0–2]; mixed model P =0.19). At 9 years, freedom from structural valve deterioration and reintervention was 81.6% (95% CI , 71.5%–91.6%) versus 43.4% (95% CI , 23.6%–63.2%) in the homograft and bioprosthesis groups, respectively (adjusted hazard ratio, 0.27; 95% CI , 0.13–0.55; P <0.001). Conclusions When compared with bioprostheses, pulmonary homografts were associated lower transvalvular gradient during follow‐up and were associated with a significantly lower risk of reintervention or structural valve degeneration.