Mechanical valves in the pulmonary position: An international retrospective analysis.

Autor:	Pragt H; Center for Congenital Heart Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., van Melle JP; Center for Congenital Heart Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Javadikasgari H; Department of Cardiovascular Surgery, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran., Seo DM; Department of Cardiovascular Surgery, Konkuk University Medical Center, Seoul, Republic of Korea., Stulak JM; Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minn., Knez I; Division of Cardiac Surgery, Medical University of Graz, Graz, Austria., Hörer J; Department of Cardiovascular Surgery and Pediatric Cardiology and Congenital Heart Disease, German Heart Center at the Technical University, Munich, Germany., Muñoz-Guijosa C; Integrated Adult Congenital Cardiac Clínic of Vall d'Hebron and Sant Pau University Hospitals, Barcelona, Spain., Dehaki MG; Department of Cardiovascular Surgery, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran., Shin HJ; Department of Cardiovascular Surgery, Konkuk University Medical Center, Seoul, Republic of Korea., Dearani JA; Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minn., Dehaki MG; Department of Cardiovascular Surgery and Pediatric Cardiology and Congenital Heart Disease, German Heart Center at the Technical University, Munich, Germany., Pieper PG; Center for Congenital Heart Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Eulenburg C; Medical Statistics and Decision Making, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Dos L; Integrated Adult Congenital Cardiac Clínic of Vall d'Hebron and Sant Pau University Hospitals, Barcelona, Spain., Ebels T; Center for Congenital Heart Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: T.Ebels@umcg.nl.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2017 Oct; Vol. 154 (4), pp. 1371-1378.e1. Date of Electronic Publication: 2017 May 20.
DOI:	10.1016/j.jtcvs.2017.04.072
Abstrakt:	Objective: Life expectancy of patients with congenital heart disease has improved over the past decades, increasing the need for a durable pulmonary prosthetic valve. Biological valves in various forms have become the valve of choice for pulmonary valve replacement (PVR), but structural valve deterioration is unavoidable in the long term. Use of a mechanical valve could be an alternative, but data on long-term outcomes are sparse. Methods: We retrospectively collected and analyzed data on 364 patients with mechanical valves implanted in the pulmonary position between 1965 and 2014. The data originate from medical centers in Barcelona (Spain), Graz (Austria), Groningen (the Netherlands), Munich (Germany), Rochester (United States), Seoul (Republic of Korea), and Tehran (Iran). Results: Median follow-up duration was 4.26 years (range, 0-27 years), mean age at implantation was 27.16 ± 12.2 years. Tetralogy of Fallot was the most common primary cardiac diagnosis, with a subgroup of 69.8%. Freedom from valvular thrombosis was 91% (95% confidence interval [CI], 87%-94%) at 5 years and 86% (95% CI, 81%-91%) at 10 years post-PVR. With a success rate up to 88%, thrombolysis was a successful therapy. Freedom from reoperation was 97% (95% CI, 94%-99%) at 5 years post-PVR and 91% (95% CI, 85%-95%) at 10 years. Conclusions: Mechanical PVR is associated with a limited risk of valvular thrombosis. Thrombolysis was an effective treatment in the majority. (Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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