Is Redo Complete Valved Pulmonary Trunk Replacement a Safe and Effective Approach?

OBJECTIVES: Surgical pulmonary valve replacement (PVR) is the most common cardiac operation in adults with congenital heart disease (ACHD). Nearly one quarter of all cardiac procedures in this population are PVRs, and approximately 96% are redo surgeries. This study aimed to compare operative and early postoperative outcomes in patients undergoing first-, second-, and third-or-more-time PVR. METHODS: We retrospectively analyzed 104 consecutive adult patients with repaired congenital heart disease who underwent total valved pulmonary trunk replacement at our institution between January 2014 and March 2022. RESULTS: Fifty-three patients underwent first-time PVR, 31 second-time PVR, and 20 third-or-more-time PVR. All patients had at least one previous sternotomy. In all redo procedures, extended resection of the degenerated pulmonary valve graft was performed. Operative complexity increased with the number of previous PVRs, reflected by significantly longer cardiopulmonary bypass times (134 vs. 185 vs. 222 min) and aortic cross-clamp times (68 vs. 91 vs. 114 min; p<0.001). Postoperative length of stay was also longer with increasing number of prior PVRs (7 vs. 10 vs. 8 days; p=0.012). Despite increased surgical complexity, no significant differences (p>0.05) were observed in intraoperative or postoperative complications, postoperative peak transvalvular gradients, or relevant valve regurgitation. Overall mortality was low. Three patients died, two of whom had a history of endocarditis. CONCLUSION: Patients undergoing multiple PVRs demonstrate early clinical outcomes comparable to those undergoing first-time PVR despite increased surgical complexity. Endocarditis remains a major risk factor in redo PVR surgery.