Outcomes after implantation of right-sided mechanical valve prostheses in congenital heart disease
Authors' conclusion
Patients that received right-sided mechanical valve prostheses had lower temporal increase in valve gradient, lower risk of prosthetic valve dysfunction, but higher risk of bleeding complications compared with those that underwent right-sided bioprosthetic valve implantation.
Study context
- Population
- Adults with congenital heart disease undergoing pulmonary valve replacement (PVR) or tricuspid valve replacement (TVR) at Mayo Clinic Rochester, 2003–202148 mechanical-valve cases, 1:2 matched
- Participants
- 39 / 17 / 78 / 34
- Comparison
- Mechanical vs bioprosthetic right-sided valve replacement
- Mechanical PVRn = 39
- Mechanical TVRn = 17
- Bioprosthetic PVRn = 78reference
- Bioprosthetic TVRn = 34reference
- Outcome
- Prosthetic valve function and outcomes (prosthetic valve dysfunction, reoperations, major bleeding events)
Methodological details1:2 matching, single-centre
- 1:2 matching
- Single-centre
Main finding
As reported in the abstract
Prosthetic valve dysfunction
Mechanical PVR
1.0% /year
Bioprosthetic PVR
2.8% /year
Mechanical TVR
2.6% /year
Bioprosthetic TVR
4.3% /year
Mechanical PVR vs Bioprosthetic PVR: P = 0.02 · Mechanical TVR vs Bioprosthetic TVR: P = 0.008
Observational data: associations, not effects.
Further findings
| Outcome | Mechanical PVR | Mechanical TVR | Bioprosthetic PVR | Bioprosthetic TVR | P value |
|---|---|---|---|---|---|
| Temporal change in Doppler systolic mean gradient after PVRMechanical PVR vs Bioprosthetic PVR | −1 ± 2 mm Hg | — not stated in the abstract | 3 ± 2 mm Hg | — not stated in the abstract | P < 0.001 |
| Temporal change in Doppler diastolic mean gradient after TVRMechanical TVR vs Bioprosthetic TVR | — not stated in the abstract | 0 ± 1 mm Hg | — not stated in the abstract | 2 ± 1 mm Hg | P = 0.005 |
— not stated in the abstract
Safety
| Outcome | Mechanical | Bioprosthesis | P value |
|---|---|---|---|
| Major bleeding events | 2.2% /year | 0.1% /year | P < 0.001 |
Original publication
Outcomes after implantation of right-sided mechanical valve prostheses in congenital heart disease. Heart. Published 5 July 2023. doi:10.
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