Interdiscip Cardiovasc Thorac Surg. 2025 Sep 24:ivaf214. doi: 10.1093/icvts/ivaf214. Online ahead of print.
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 UK and Ireland. Information was sought on preferred prostheses, factors influencing decision-making, implant technique, postoperative anticoagulation, practice variations in adolescents, and willingness to randomise patients to different prostheses within a trial.
RESULTS: Responses were obtained from 27 (69%) surgeons. 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. 22 (81%) surgeons were willing to randomise adult patients to either a bovine pericardial valve or porcine xenograft in a clinical trial, with Perimount Magna Ease and Hancock II the most acceptable, respectively. Willingness to randomise 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.
PMID:40991337 | DOI:10.1093/icvts/ivaf214
