Long-Term Outcomes After Pulmonary Valve Repair for Regurgitation Secondary to Prior Intervention

Purpose: Pulmonary valve (PV) regurgitation (PR) secondary to prior repair of congenital heart disease commonly necessitates intervention, typically with PV replacement (PVR). However, prosthetic valves are susceptible to degeneration and ultimately require reintervention. Pulmonary valve repair (PVr) can correct PR while retaining native tissue, but long-term durability is unknown. Methods: All patients who underwent PVr from 2010 to 2018 for PR resulting from prior PV intervention were included. A control cohort included patients who underwent PVR during the same period for the same indications. Time-related outcomes including freedom from right ventricular outflow tract reintervention, moderate or greater PR, and a maximum Doppler gradient ≥36 mm Hg were compared. Approved as IRB-65340. Results: The study included 33 and 151 patients who underwent PVr and PVR, respectively, 72% (132/184) with tetralogy of Fallot. Patients were followed for a median of 9.0 years (6.4-11.5) and 7.7 years (5.4-9.9), respectively (P =.041). Estimated freedom from reintervention 5 and 10 years after discharge was 97% (80-100) and 89% (69-96) after PVr and 96% (92-99) and 79% (67-87) after PVR. On Cox regression analysis adjusted for age or weight at the time of surgery, and on multivariable Cox regression, PVr was associated with significantly longer freedom from reintervention and valve dysfunction than PVR. Conclusions: Pulmonary valve repair was associated with longer freedom from valve dysfunction and reintervention than PVR, particularly in pediatric patients. Lifetime management should be considered at original repair, with an effort to maintain native tissue for potential future PVr.