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

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.