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Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
Published on: June 8, 2022
Is Redo Complete Valved Pulmonary Trunk Replacement a Safe and Effective Approach?
Tomislav Cvitkovic1, Murat Avsar1, Theresa Holst2
1Hannover Medical School, Departement for Cardiac, Thoracic, Transplantation and Vascular Surgery, Germany, Hannover.
The Thoracic and Cardiovascular Surgeon
|May 12, 2026
Summary
Redo pulmonary valve replacement (PVR) in adults with congenital heart disease shows outcomes similar to first-time PVR, despite increased surgical complexity. Endocarditis is a key risk factor in repeat PVR procedures.
Area of Science:
- Cardiology
- Cardiac Surgery
- Adult Congenital Heart Disease
Background:
- Pulmonary valve replacement (PVR) is the most frequent cardiac surgery for adults with congenital heart disease (ACHD).
- A significant majority (96%) of these PVR procedures are repeat surgeries.
- Understanding outcomes for multiple PVRs is crucial for managing ACHD patients.
Purpose of the Study:
- To compare operative and early postoperative outcomes of first-time, second-time, and third-or-more-time PVR.
- To evaluate the impact of surgical complexity on patient outcomes in redo PVR.
Main Methods:
- Retrospective analysis of 104 adult ACHD patients undergoing total valved pulmonary trunk replacement.
- Data collected between January 2014 and March 2022.
- Comparison of outcomes based on the number of previous PVRs.
Main Results:
- Operative times (bypass and cross-clamp) significantly increased with each subsequent PVR.
- Postoperative length of stay was longer for patients with more prior PVRs.
- Despite increased complexity, no significant differences in complications, gradients, or regurgitation were found between groups. Mortality was low, with endocarditis a risk in redo cases.
Conclusions:
- Multiple PVRs in ACHD patients yield early clinical outcomes comparable to first-time PVR.
- Increased surgical complexity in redo PVR does not translate to worse early outcomes.
- Endocarditis is a significant risk factor that requires careful consideration in redo PVR surgery.
