Long-term durability of surgical and transcatheter bioprosthetic pulmonary valves BPV durability: time to dysfunction and failure

Pulmonary valve replacements (PVR) with bioprosthetic pulmonary valves (BPV) increases. This study aimed to assess BPV durability as time to dysfunction and failure, risk factors for reduced durability, and impact on mortality.

Data from a Danish nationwide cohort who underwent surgical or transcatheter PVR with a BPV between 1976 and 2021 were obtained. Bioprosthetic valve dysfunction was categorized into (i) structural valve deterioration (SVD) as moderate [pulmonary stenosis (PS) with peak velocity >3 m/s = PG ≥ 36 mm Hg or >mild pulmonary regurgitation] or severe (>4 m/s = PG ≥ 64 mm Hg or severe regurgitation), (ii) patient-prosthesis mismatch (PPM) (PG ≥ 20 mm Hg on the last echocardiography ≤90 days), and (iii) infective endocarditis (IE). Bioprosthetic valve failure (BVF) was defined as redo PVR. 680 PVRs were performed in 439 patients. Median follow-up was 14 years [Inter-quartile range (IQR): 8–21]. Median time to moderate SVD was 6 years (IQR: 1–17), to severe SVD 21 years (IQR: 17-NA), and to BVF 17 years (IQR: 15–18). PPM occurred in 41%. Cumulative incidence of IE was 17% after 25 years. PS was the leading cause of moderate (62%) and severe SVD (54%), then regurgitation (32% and 43%) and combined disease (6% and 3%). Younger age at PVR and PPM was associated with increased risk of SVD and BVF, while PPM and redo-interventions increased risk of IE. SVD was not associated with mortality (P = .08 for moderate, P = .56 for severe SVD).

Moderate dysfunction occurred early after PVR, but takes years to progress to severe dysfunction or failure. Younger age and PPM increased SVD and BVF risk. PPM and redo-interventions increased IE risk. SVD was not associated with mortality.