Medtronic freestyle valves in right ventricular outflow tract reconstruction.
BACKGROUND
Various pulmonary valve substitutes, with their inherent limitations, have been used in children and young adults. We chose the Medtronic Freestyle (Medtronics, Minneapolis, MN) valve because of its excellent hemodynamics, known durability in adults, and design features that allow modifications during implantation.


METHODS
Over a 3 1/2 year period the Freestyle valve was implanted in 47 patients age 2 to 58 years (mean 14.2, median 12.0) in the pulmonary position. All patients had pulmonic stenosis and(or) insufficiency from previous operations for tetralogy (27), pulmonary atresia (6), truncus (4), or other diagnosis (10). The indication for surgery was pure pulmonary insufficiency in 11 patients, pulmonic stenosis in 3, and mixed stenosis and insufficiency in 33. Root replacement technique was used with additional enlargement of the pulmonary artery branches in 10 patients.


RESULTS
Intraoperatively, one patient sustained a right ventricle tear and one a circumflex coronary artery injury during the dissection. There was one postoperative death. Two patients developed late subvalvular pannus formation, one of whom required reoperation. One patient was found to have an echo gradient of 95 mm Hg due to decreased leaflet motion and underwent cardiac catheterization at which the peak systolic gradient was determined to be 50 mm Hg. He has not required reintervention during his 3 1/2 years of follow-up. The remaining 43 patients have minimal gradients or insufficiency. All surviving patients are in New York Heart Association (NYHA) Class I.


CONCLUSIONS
The Medtronic Freestyle valve is an attractive alternative for RVOT (right ventricular outflow tract) reconstruction in children. It is readily available, versatile, and has excellent hemodynamic characteristics. Although long term follow-up is not yet available, longevity of this prosthesis, and freedom from complications, will hopefully be superior to valves with stents.
Hartz
Renee S
RS
Department of Surgery and Pediatrics, Tulane University Medical Center, New Orleans, Louisiana, USA.
Deleon
Serafin Y
SY
Lane
Jason
J
Dorotan
Jamie
J
Joyce
James
J
Urbina
Elaine
E
Ross-Ascuitto
Nancy
N
Ascuitto
Robert
R
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011651:Pulmonary Artery / Q000601:surgery; D011664:Pulmonary Valve / Q000601:surgery; D014694:Ventricular Outflow Obstruction / Q000601:surgery*