Pulmonary Valve Replacement in Tetralogy of Fallot: Procedural Volume and Durability of Bioprosthetic Pulmonary Valves

Mathis Gröning*, Morten Holdgaard Smerup, Kim Munk, Helle Andersen, Dorte Guldbrand Nielsen, Henrik Nissen, Ulrik Markus Mortensen, Annette Schophuus Jensen, Pernille Steen Bække, Jesper Bjerre, Morten Engholm, Niels Vejlstrup, Klaus Juul, Eva Vad Søndergaard, Hans Gustav Hørsted Thyregod, Henrik Ørbæk Andersen, Morten Helvind, Ole De Backer, Christian Jøns, Michael Rahbek SchmidtTroels Højsgaard Jørgensen, Lars Sondergaard

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review


Background: Robust data on changes in pulmonary valve replacement (PVR) procedural volume and predictors of bioprosthetic pulmonary valve (BPV) durability in patients with tetralogy of Fallot (TOF) are scarce. Objectives: This study sought to assess temporal trends in PVR procedural volume and BPV durability in a nationwide, retrospective TOF cohort. Methods: Data were obtained from patient records. Robust linear regression was used to assess temporal trends in PVR procedural volume. Piecewise exponential additive mixed models were used to estimate BPV durability, defined as the time from implantation to redo PVR with death as a competing risk, and to assess risk factors for reduced durability. Results: In total, 546 PVR were performed in 384 patients from 1976 to 2021. The annual number of PVR increased from 0.4 to 6.0 per million population (P < 0.001). In the last decade, the transcatheter PVR volume increased by 20% annually (P < 0.001), whereas the surgical PVR volume did not change significantly. The median BPV durability was 17 years (Q1: 10-Q3: 10 years-not applicable). There was no significant difference in the durability of different BPV after adjustment for confounders. Age at PVR (HR: 0.78 per 10 years from <1 year; 95% CI: 0.63-0.96; P = 0.02) and true inner valve diameter (9-17 mm vs 18-22 mm HR: 0.40; 95% CI: 0.22-0.73; P = 0.003 and 18-22 mm vs 23-30 mm HR: 0.59; 95% CI: 0.25-1.39; P = 0.23) were associated with reduced BPV durability in multivariate models. Conclusions: The PVR procedural volume has increased over time, with a greater increment in transcatheter than surgical PVR during the last decade. Younger patient age at PVR and a smaller true inner valve diameter predicted reduced BPV durability.

Original languageEnglish
JournalJACC: Cardiovascular Interventions
Pages (from-to)217-227
Number of pages11
Publication statusPublished - Jan 2024


  • bioprosthetic pulmonary valves
  • durability
  • procedural volume
  • pulmonary valve replacement
  • tetralogy of Fallot


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