Long-term results of valve replacement in the right side of the heart in congenital heart disease--comparative study of bioprosthetic valve and mechanical valve

Valve replacements in the right side of the heart (TVR and PVR) were done on 16 patients with congenital heart disease, mainly tetralogy of Fallot and Ebstein anomaly. Including reoperations, 19 operations were performed on them and 20 artificial valves were inserted. Ten mechanical valves (7 St. Jude Medical valves, 3 Starr-Edwards valves) and 10 bioprosthetic valves (7 Carpentier-Edwards valves, 3 Ionescu-Shiley valves) were used. Age at valve replacement ranged from 9 to 52 years (mean 23.0 years), and the follow-up period was 1.28-19.8 years (mean 5.7 years). Including 2 sudden deaths, late death occurred in 4 patients, on all of whom mechanical valve replacements were done at the primary operation. Five-year survival rate of all patients was 76.4 +/- 12.1%, and 10-year survival rate was 63.6 +/- 15.4%. All the patients who received bioprosthesis at the primary operation survived at the time of this follow-up study. On the contrary, long-term results of mechanical valve was unsatisfactory with the 5-year survival of 62.5 +/- 17.1%. In spite of anti-coagulation therapy with warfarin, three patients with mechanical valve complicated thrombotic valves, which necessitated re-operations. Calcified bioprosthetic valve occurred in one patient with I-S valve 8.5 years after the implantation. Five-year complication-free rate was 87.5 +/- 11.7% for bioprosthesis, whereas it was 50.0 +/- 15.8% for mechanical valve (p less than 0.056). It is concluded that the bioprosthesis is the first choice for the valve replacement in the right side of the heart in congenital heart disease.