Early inspiris resilia valve failure in a patient with idiopathic pulmonary valve regurgitation.

Abstract

Background: Pulmonary valve failure requiring replacement (PVR) is more commonly seen in children and young adults with congenital heart disease (CHD). Adults with CHD and pulmonary regurgitation have traditionally undergone PVR with bioprosthetic valves. The inspiris resilia bovine pericardial valve is an FDA-approved bioprosthesis for the aortic position with encouraging data on 7-year outcomes. Previous reports on PVR using the Inspiris valve in young patients with CHD have demonstrated early failure of the valve. We report the early failure of this device in an elder patient with idiopathic pulmonary regurgitation.

Case presentation: The patient is a 69-year-old male with preoperative evaluation demonstrating idiopathic pulmonary valve regurgitation with moderately depressed right ventricular ejection fraction. The patient declined receiving a porcine valve, and therefore underwent PVR using the inspiris resilia (IR) valve due to known encouraging results when implanted in the aortic position in elder patients. A 27 mm IR valve was utilized, and intraoperative transesophageal echocardiography showed no regurgitation at the time of surgery. Surveillance echocardiography at 17 months, however, already demonstrated moderate to severe pulmonary prosthetic valve regurgitation.

Conclusions: This report highlights an early failure of the IR valve used for PVR in an elder patient with idiopathic pulmonary regurgitation. Data on the IR valve in the pulmonic position is limited to mostly small cohorts of young patients with CHD, and immediate outcomes are nearly universally satisfactory. However, recent reports in this specific population indicate early recurrence of regurgitation in the IR cohort compared to patients managed with a commercially available porcine aortic bioprosthetic valve, when used in the pulmonic position. Our reported case suggests that utilization of IR in the pulmonic position should be approached with caution in elderly patients as well.