Long-term Outcomes of Pulmonary Valve Replacement in Infancy: Time for a Reassessment?

Background: Congenital heart disease (CHD) is one of the leading causes of morbidity and mortality in children. Among these conditions, pulmonary valve (PV) defects may occur as isolated lesions or as part of more complex cardiac malformations. Pulmonary valve replacement (PVR) is a common surgical intervention; however, data on its long-term outcomes in neonates and infants remain limited, particularly given the influence of patient growth on prosthetic performance. Objectives: To evaluate the long-term outcomes and durability of pulmonary valve replacement in neonates and infants. Methods: A retrospective review was conducted of 62 neonates and infants who underwent PVR across 22 centers over a 25-year period. Surgical outcomes, long-term follow-up data, and the need for reoperation were analyzed. Complete long-term outcome records were available for 22 patients. Results: The study demonstrated variable long-term durability of PVR in neonates and infants, with several patients requiring reoperation during follow-up. Factors such as somatic growth and prosthetic valve limitations appeared to contribute to the need for subsequent interventions. Conclusion: These findings highlight the need to reassess current strategies for pulmonary valve replacement. Alternative approaches, including partial heart transplantation, may offer improved long-term outcomes for this patient population and warrant further investigation.