title: Pericardial tissue valves and Gore-Tex conduits as an alternative for right ventricular outflow tract replacement in children.
abstract: BACKGROUND
  There is still no perfect conduit for reconstruction of the right ventricular outflow tract (RVOT) in children. Homografts are not always available in the appropriate size, and degenerate in a few years. This study evaluates the pericardial valve with Gore-Tex conduit as an alternative for RVOT construction.
  
  
  METHODS
  From January 1, 1993, to September 30, 1999, a pericardial tissue valve was inserted in all patients undergoing RVOT reconstruction or pulmonary valve replacement (PVR) who were large enough to accommodate a tissue valve. In patients without a native main pulmonary artery, a new technique was used to construct an RV-PA conduit out of a flat sheet of Gore-Tex, as Dacron frequently leads to stenosis. Data were collected by retrospective review, follow-up echocardiograms, and assessment by a single cardiologist.
  
  
  RESULTS
  There were 48 patients, 22 undergoing a PVR alone and 26 a RV-PA valved Gore-Tex conduit. Diagnosis included tetralogy of Fallot (n = 25); truncus arteriosis (n = 9); ventricular septal defect with PA (n = 5); DORV (n = 4); D-TGA with PS (n = 2); and 1 each IAA with sub AS, VSD with PI, and PS s/p Ross procedure. Patient age ranged from 3 to 33 years and 98% were reoperations. The valve sizes ranged from 19 to 33 mm and the median hospital length of stay was 4 days. There were 2 (4.2%) perioperative and 1 (2.1%) late deaths, none related to the valve or Gore-Tex conduit. At a follow-up of 15 to 86 months (mean 43 +/- 16 months), all remaining 45 patients are New York Heart Association class I, all valves are functional, and no patient has required valve or conduit replacement or revision; more importantly, echocardiogram revealed no significant valve or conduit stenosis (mean gradient 16 +/- 8 mm Hg) and no evidence of regurgitation or structural degeneration.
  
  
  CONCLUSIONS
  A pericardial tissue valve and Gore-Tex conduit provides a reliable alternative for RVOT reconstruction in pediatric patients. It is readily available, molds in the limited retrosternal space, and has outstanding intermediate results with no evidence of failure or deterioration up to 7 years after insertion.
authors.affiliation: Division of Cardiovascular Surgery, Heart Institute for Children, Hope Children's Hospital, Oak Lawn, Illinois 60453, USA. bradallen@thic.com
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Allen
authors.forename: Chawki
authors.initials: C
authors.lastname: El-Zein
authors.forename: Betina
authors.initials: B
authors.lastname: Cuneo
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Cava
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Barth
authors.forename: Michel N
authors.initials: MN
authors.lastname: Ilbawi
mesh_terms: D000293:Adolescent; D000328:Adult; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D014694:Ventricular Outflow Obstruction / Q000601:surgery*
chemical_list: D011138:Polytetrafluoroethylene