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Original research article
Surgical and percutaneous pulmonary valve replacement in England over the past two decades
  1. Signe H Larsen1,2,
  2. Konstantinos Dimopoulos1,3,
  3. Michael A Gatzoulis1,3,
  4. Anselm Uebing1,3,
  5. Darryl F Shore1,3,
  6. Rafael Alonso-Gonzalez1,3,
  7. Aleksander Kempny1,3
  1. 1Adult Congenital Heart Centre, Royal Brompton Hospital, London, UK
  2. 2Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
  3. 3National Heart and Lung Institute, Imperial College, London, UK
  1. Correspondence to Dr Signe H Larsen, Adult Congenital Heart Centre, Royal Brompton Hospital, London SW3 6NP, UK; signe_holm_larsen{at}hotmail.com

Abstract

Objective Pulmonary valve replacement (PVR) is often required in patients with congenital heart disease. We aimed to describe temporal trends in PVR in a nationwide English cohort between 1997 and 2014, survival and the need for re-PVR.

Methods Patients were identified in the Hospital Episode Statistics Database. Survival data were retrieved from the UK Office for National Statistics.

Results A total of 2733 patients underwent PVR (2845 procedures) over the study period. Median age at first procedure increased from 20.1 years in 1997–2005 to 24.7 years in 2006–2014. The annual number of PVRs increased from 23 in 1997 to 251 in 2014. Homografts were the most common choice in the early years, but the use of xenografts increased after 2005. During a median follow-up of 5.8 years, 176 patients died and 108 required redo PVR. Early (30 day) survival was 98% for all PVRs and was similar for all types of prostheses but longer-term mortality dropped to 92% at 10 years and 90% at 15 years. Age >16 years and percutaneous PVR were risk factors for death. The cumulative incidence for re-PVR at 10 years was 8% for all PVRs and 11% at 15 years. Risk factors for re-PVR were complex diagnosis, male gender and black ethnicity.

Conclusion There was a significant increase in the number of PVRs performed in England over the last two decades and a significant change in the type of prosthesis employed. While early mortality was low across the board, longer-term mortality was not negligible in this young population.

  • congenital heart disease surgery
  • congenital heart disease
  • pulmonic valve disease
  • epidemiology

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Footnotes

  • Patient consent for publication Not required.

  • Contributors SHL: design of study, data analysis, interpretation of data, drafting of manuscript, critical revision of manuscript, and approval of manuscript; responsible for overall content. KD, MAG, AU, DFS, RA-G and AK: design of study, data analysis, interpretation of data, critical revision of manuscript and approval of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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