Long‐Term Comparison Between Pulmonary Homograft Versus Bioprosthesis for Pulmonary Valve Replacement in Tetralogy of Fallot. Issue 24 (17th December 2019)

• Record Type: Journal Article
• Authors: Cocomello, Lucia; Meloni, Marco; Rapetto, Filippo; Baquedano, Mai; Ordoñez, Maria Victoria; Biglino, Giovanni; Bucciarelli‐Ducci, Chiara; Parry, Andrew; Stoica, Serban; Caputo, Massimo
• Is Part Of: Journal of the American Heart Association. Volume 8:Issue 24(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-12-17
• Subjects: bioprosthesis -- homograft -- pulmonary heart disease -- regurgitation -- structural valve degeneration -- tetralogy of Fallot; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.119.013654
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : 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.