Pulmonary Valve Replacement in Adults and Adolescents With Congenital Heart Disease: A United Kingdom and Ireland Survey.

Abstract

Objectives: Many models of bioprosthesis are available for pulmonary valve replacement in adults with congenital heart disease, but there is a lack of randomized evidence to guide practice. We surveyed congenital cardiac surgeons to establish current practice and willingness to change within a clinical trial.

Methods: An online survey was sent to all consultant congenital cardiac surgeons in adult congenital centres in the United Kingdom and Ireland. Information was sought on preferred prostheses, factors influencing decision-making, implant technique, postoperative anticoagulation, practice variations in adolescents, and willingness to randomize patients to different prostheses within a trial.

Results: Responses were obtained from 27 (69%) surgeons. A total of 19 (70%) preferred an Edwards bovine pericardial valve, most commonly the Inspiris Resilia (7, 26%). Only 2 (7%) favoured the Hancock II valve; the remaining 6 (22%) preferred pulmonary homografts. Data regarding long-term freedom from reintervention (23, 85%) was the most important factor influencing prosthesis choice. A total of 22 (81%) surgeons were willing to randomize adult patients to either a bovine pericardial valve or a porcine xenograft in a clinical trial, with Perimount Magna Ease and Hancock II being the most acceptable, respectively. Willingness to randomize dropped to 11 (41%) surgeons for adolescent patients.

Conclusions: This survey demonstrates heterogeneity in the choice of pulmonary valve prosthesis. Combined with a lack of evidence from clinical trials, our findings support the presence of clinical equipoise. Most surgeons are willing to change practice, suggesting that a pragmatic, multicentre, randomized controlled trial comparing bovine pericardial versus porcine xenograft for pulmonary valve replacement in adults is feasible.