Ergebnisse nach Pulmonalklappenrekonstruktionen

Pulmonary valve regurgitation is a common problem after surgical or interventional relief of right ventricular outflow tract (RVOT) obstructions. Pulmonary valve replacement with a homograft or xenograft is the routine treatment. The longevity of biological valves and the availability of homografts are limited. This study presents intermediate-term results for pulmonary valve reconstruction (PVr) in patients with severe regurgitation.

Perioperative data, preoperative and postoperative cardiac magnetic resonance imaging (MRI) studies, freedom from valve replacement and risk factors for pulmonary valve dysfunction were analyzed. Early postoperative results and effects on right ventricular volume development were compared to a matched group of patients who received pulmonary valve replacement with a homograft.

A PVr was performed in 24 patients. The median age was 18 years (14–24 years). The median follow-up after the operation was 8.0 years (4.7–9.7 years). Freedom from valve failure was 96% after 2 years and 90% after 5 years. Magnetic resonance imaging (MRI) before and 6 months after surgery showed a significant reduction in the median regurgitation fraction from 41% to 21% (p = 0.001) and a decrease of indexed right ventricular end-diastolic volume from 156 ml/m² (149–177 ml/m²) to 117 ml/m² (103–142ml/m², p = 0.004). In comparison to a group of homograft patients the regurgitation fraction was significantly higher (21% vs. 8%, p = 0.003), indexed end-diastolic right ventricular volumes showed no significant differences with 117ml/m² (103–142 ml/m²) vs. 116ml/m² (102–133ml/m²), p = 0.759).

A PVr can be carried out in certain patients with acceptable intermediate-term results and can delay pulmonary valve replacement.