Evolving Solutions in the Surgical Treatment of Isolated Pulmonary Valve Stenosis

Background. Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. In our study, we sought to analyze the effect of such evolving philosophy on mid-term results.Methods. 123 consecutive patients were treated in our center between 07/1983 and 03/2019. Mean age and weight were 3.0 ± 0.36 years and 16.6 ± 1.7 kg, respectively. Patients were categorized into 2 groups based on the onset of sparing valve techniques (1995). Short- and long-term mortality, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease and pulmonary valve insufficiency were analyzed.Results. Early mortality occurred exclusively before 1995 (Group 1, 3.76%, p=ns). Transvalvular mean pressure gradient decreased in the entire patient population (from 63.28 ± 12.9 mmHg to 16.46 ± 7.9 mmHg), but right outflow tract reintervention rate was greater in Group 1 (14.10% vs 2.3%, p = 0.04). At a mean follow-up interval of 4.9 ± 33 years, pulmonary valve insufficiency was severe in 2.47% of patients in Group 1, whereas it was mild to moderate in 33.3% of patients in Group 2, the latter having undergone unsuccessful percutaneous balloon valvuloplasty prior to surgery in the vast majority of cases (14/20 vs 6/22, p=0.023).Conclusions. Current pulmonary valve sparing techniques are associated with better results, both in terms of survival and freedom from re-intervention at follow-up. Balloon valvuloplasty prior to surgery may worsen operative results, promoting pulmonary insufficiency and therefore should probably be avoided in all patients in whom anatomical characteristics predict failure of percutaneous therapy.