Stentless bioprosthetic valve effective for patients with congenital heart disease

Issue: April 2015

A stentless bioprosthetic valve used to replace the pulmonary valve in patients with congenital heart disease was associated with good clinical outcomes, researchers reported at Cardiology 2015, the 18th Annual Update on Pediatric and Congenital Cardiovascular Disease.

Perspective from David Goldberg, MD

Ben M. Dunne, MB, BCh, BAO, MRCS, and colleagues conducted a retrospective review of pulmonary valve replacements with the stentless bioprosthetic valve (Freestyle, Medtronic) in 114 patients with congenital heart disease (70 men; mean age, 23.5 years) performed during a 14-year period by a single surgeon, David R. Andrews, FRACS. The researchers contacted patients to determine survival, NYHA class and reintervention, and performed up-to-date echocardiography to assess valve function. Mean clinical follow-up was 71 months; mean echocardiographic follow-up was 61 months.

According to results reported by Dunne, the 14-year survival rate was 94.8%.

Thirty-one patients had NYHA class III or IV HF before surgery compared with just six when contacted for follow-up.

At 10 years, the rate of freedom from reintervention was 74.5% and the rate of freedom from structural valve deterioration was 60.9%.

“In particular, those with a body surface area greater than 1.5 m², age over 10 years and receiving a conduit of greater than 23 mm in diameter performed even better in terms of freedom from reintervention,” said Dunne, from Royal Perth Hospital.

The only independent predictor for reintervention was age 10 years or younger at time of pulmonary valve replacement, according to the researchers. Patients older than 10 years at the time of surgery had a rate of freedom from reintervention at 10 years of 86.5% vs. 47.5% for patients aged 10 years or younger at the time of surgery (HR = 0.09; P = .046).

Dunne and colleagues also found a trend toward increased risk for structural valve deterioriation at 10 years with younger age at time of surgery (older than 10 years, 79.8%; 10 years and younger, 28.4%; HR = 0.17; P = .06).

“These results compare very favorably and perform as well as or better than any published series on homografts or bioprostheses in the pulmonary position in a congenital population,” he said. “We feel [that] the Freestyle valve provides an excellent option, particularly in adolescents and adults requiring pulmonary valve replacement late after tetralogy repair.” – by Erik Swain

Reference:

Dunne BM, et al. Abstract 936. Presented at: Cardiology 2015, the 18th Annual Update on Pediatric and Congenital Cardiovascular Disease; Feb. 11-15, 2015; Scottsdale, Ariz.

Disclosure: Dunne reports no relevant financial disclosures.

Perspective

David Goldberg, MD

In the current era, valve replacement is changing. There are new alternatives in terms of catheter-delivered valves as well as more modern surgically implanted valves. I think it’s important to demonstrate that the new valves are useful, that they have a good safety profile, and that the patients do well after valve implantation. An analysis like this adds to that literature and helps the congenital community feel good about what the options are.

David Goldberg, MD

Attending cardiologist, Children’s Hospital of Philadelphia

Disclosures: Goldberg reports no relevant financial disclosures.