Impact of Anticoagulation Therapy after Bioprosthetic and Homograft Pulmonary Valve Replacement.

Background: The effect of anticoagulation on early postoperative outcomes following pulmonary valve replacement (PVR) with bioprosthetic valves and homografts is not yet defined. We hypothesized that short-term anticoagulation would be associated with improved valve durability.

Methods: Patients undergoing PVR or right ventricle-pulmonary artery conduits with a bioprosthetic or homograft valve >15 mm in diameter between 1/2015 and 4/2021 at Boston Children's Hospital were retrospectively compared by anticoagulation status. Survival, postoperative echocardiographic data, and the incidence of pulmonary valve reintervention and prosthetic valve dysfunction were compared using multivariable Cox and logistic regression analyses adjusted for a propensity score based on anticoagulation therapy.

Results: Among a total of 531 patients with a median follow-up of 1.16 years, 130 received anticoagulation therapy. Freedom from reintervention was 99%, 92%, and 86% at 1, 3, and 5 years, respectively. Adjusted for propensity score, there was no association between reintervention and anticoagulation (hazard ratio 0.78 [95% CI: 0.18-3.47], p=0.75). The propensity-score-adjusted rates of valve dysfunction were 9% in anticoagulated patients and 15% in nonanticoagulated patients (odds ratio 0.54 [95% CI 0.18-1.56], p=0.25). There was no difference in early major bleeding rates between groups (3.4% vs. 2.4%, p=0.59) nor other postoperative outcomes. Only 1/18 (6%) of all bleeding events in the anticoagulated group occurred after starting anticoagulation.

Conclusions: Anticoagulation therapy appeared safe with no association with major postoperative bleeding. However, additional follow-up is necessary to assess its impact on mid- to long-term valve durability following PVR.