ALERT!
This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Redo Pulmonary Valve Replacement With Right Atrial Appendage
Al Baghdady M, Amara M, Ibrahim Al-Qassas A, et al. Redo Pulmonary Valve Replacement With Right Atrial Appendage. May 2025. doi:10.25373/ctsnet.28912430
Pulmonary valve replacement (PVR) is a frequent reintervention following initial surgical repair for various congenital cardiac pathologies. As a result of early surgical interventions for conditions such as tetralogy of Fallot (TOF), double outlet right ventricle (DORV), and ventricular septal defect with pulmonary atresia (VSD with PA), the rate of survival for these cases has improved. However, the rate of reintervention increased, accompanied by heightened morbidity and mortality risks. Diverse modalities for PVR exist, encompassing both surgical and transcatheter approaches. Bioprosthetic valves, however, exhibit a propensity for failure—approximately 80 percent at 10 years mostly due to leaflet calcification despite advancements in design and anticalcification treatments. Factors such as graft oversizing, smaller valve sizes, and younger patient age predisposes to failure, with more than 50 percent of reinterventions occurring in patients less than 18 years of age due to dystrophic calcifications and immunological reactions, representing significant risk factors (1, 2). While some bioprosthetic valves, such as Magna/Magna Ease and Perimount, demonstrate lower reintervention rates of 4 percent and 3 percent, respectively, at five-year follow-up (2), their applicability in young children requiring PVR is limited. Homografts are considered a viable option for this population; however, their durability remains questionable, with elevated failure rates observed in cases involving young age, low operative weight, small graft size, and homograft retrieval-to-cryopreservation times below 24 hours (3). Transcatheter PVR is an increasingly utilized approach, although its feasibility is center-dependent and not universally applicable, with reported valve dysfunction and reintervention rates of 53 percent and 40 percent, respectively, at 10 years (4). The utilization of the right atrial appendage (RAA) for pulmonary valve reconstruction has gained popularity across various cardiac pathologies, demonstrating favorable mid-term outcomes and potential for growth. However, its application in redo cases remains controversial due to dissection challenges and concerns regarding pliability.
This video presents a case of redo PVR following tetralogy of Fallot repair utilizing the RAA, demonstrating satisfactory pliability and valve function. This case is part of a series employing this technique, with excellent short-term outcomes up to eight months and no echocardiographic evidence of valve malfunction.
References
- Lee C, Park CS, Lee CH, Kwak JG, Kim SJ, Shim WS, Song JY, Choi EY, Lee SY. Durability of bioprosthetic valves in the pulmonary position: long-term follow-up of 181 implants in patients with congenital heart disease. J Thorac Cardiovasc Surg. 2011 Aug;142(2):351-8. doi: 10.1016/j.jtcvs.2010.12.020. Epub 2011 Feb 1. PMID: 21281951.
- Baird CW, Chávez M, Sleeper LA, Borisuk MJ, Bacha EA, Burchill L, Guleserian K, Ilbawi M, Nguyen K, Razzouk A, Shinkawa T, Lu M, Fuller SM. Reintervention rates after bioprosthetic pulmonary valve replacement in patients younger than 30 years of age: A multicenter analysis. J Thorac Cardiovasc Surg. 2021 Feb;161(2):345-362.e2. doi: 10.1016/j.jtcvs.2020.06.157. Epub 2020 Sep 10. PMID: 33069421.
- Baskett RJ, Ross DB, Nanton MA, Murphy DA. Factors in the early failure of cryopreserved homograft pulmonary valves in children: preserved immunogenicity? J Thorac Cardiovasc Surg. 1996 Nov;112(5):1170-8; discussion 1178-9. doi: 10.1016/S0022-5223(96)70130-7. PMID: 8911313.
- Jones TK, McElhinney DB, Vincent JA, Hellenbrand WE, Cheatham JP, Berman DP, Zahn EM, Khan DM, Rhodes JF Jr, Weng S, Bergersen LJ. Long-Term Outcomes After Melody Transcatheter Pulmonary Valve Replacement in the US Investigational Device Exemption Trial. Circ Cardiovasc Interv. 2022 Jan;15(1):e010852. doi: 10.1161/CIRCINTERVENTIONS.121.010852. Epub 2021 Dec 21. PMID: 34930015; PMCID: PMC8765216.
Disclaimer
The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.