Comparison of Early Outcomes of Mechanical versus Bio Prosthetic Valve in Pulmonary Position in TOF and Corrected TOF
Prateek Vaswani, Sr., Velayoudam Devagourou, Palleti Rajashekar, Minati Choudhury, S Ramakrishnan
All India Institute of Medical Sciences, New Delhi, New Delhi, India
OBJECTIVE- Pulmonary regurgitation post repair of Tetralogy of Fallot (TOF) leads to chronic right ventricular(RV) volume overload states with increasing mortality. The replacement of pulmonary valve (PVR) in repaired TOF and in some cases with primary TOF presenting in adulthood with RV dysfunction provides optimum long term results with physiological normalization. The choice of valve substitutes still remains an enigma with lack of prospective data in this regard.METHODOLOGY- A randomized prospective study was conducted assessing early outcomes of Mechanical versus Bio-prosthetic PVR in a tertiary care center between May 2018 to June 2020.RESULTS- 16 patients were enrolled in 2 groups of 8 each receiving mechanical or bio-prosthetic valves and were followed for one year. There were 5 patients of PVR with primary repair and 11 patients in which redo procedure was performed. The freedom from operation was 100 % at end of 1 year in both valves. There was one case of mechanical prosthetic valve thrombosis with one case of infective endocarditis in bio-prosthetic valve both of which were managed without surgical intervention. There was no major bleeding complication in mechanical valves. The mean INR values in mechanical was 2.97 +/- 0.45 and in bio-prosthetic was 2.26 +/- 0.19. Symptomatic and echocardiographic improvement in RV function were observed in both groups with no additional hospital morbidity. There was no mortality observed in this study.CONCLUSION- Strict adherence of anticoagulants justify safety profile, efficacy of mechanical valves in pulmonary position with similar relief of RV in both valve types.
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