Repeat right ventricular outflow tract reconstruction using the Medtronic Freestyle porcine aortic root.
OBJECTIVE
A variety of valve substitutes are used for right ventricular outflow tract (RVOT) reconstruction in children and young adults after previous RVOT surgery that has led to significant pulmonary insufficiency and/or stenosis. Herein, the authors' experience with pulmonary valve replacement (PVR) using a porcine valved conduit late after previous RVOT surgery was reviewed.


METHODS
Between August 2002 and April 2005, 31 patients (mean age 14.5 +/- 9.5 years; range: 1.2-33.1 years) underwent PVR using the Medtronic Freestyle porcine aortic root. These patients averaged two prior operations (range: 1-5) for the following diagnoses: tetralogy of Fallot +/- pulmonary atresia (n = 21); persistent truncus arteriosus (n = 5); aortic stenosis (Ross-Konno procedure) (n = 2); pulmonary atresia with intact ventricular septum; (n = 1); congenital pulmonary stenosis (n = 1); and transposition of the great arteries (n = 1). Of these patients, 29 (93.5%) underwent additional procedures at the time of pulmonary valve insertion including: branch pulmonary artery reconstruction (n = 21), atrial septal defect closure (n = 5), ascending aorta replacement (n = 4), pacemaker or defibrillator placement (n = 3), tricuspid valve repair (n = 2), ventricular septal defect closure (n = 2), and other procedures (n = 2).


RESULTS
There were no early or late deaths. The mean hospital stay was 8.3 +/- 5.9 days (range: 4-25 days). One patient had a subarachnoid hemorrhage with transient left hemiparesis, and two patients had acute tubular necrosis with temporary dialysis treatment. All patients were well at a mean follow up of 13 +/- 9.3 months (range: 0.5-31 months). Echocardiography showed trivial or no pulmonary insufficiency in 30 patients (96.7%). The calculated mean peak systolic RVOT gradient by echocardiography was 23.4 +/- 7.6 mmHg.


CONCLUSIONS
The Medtronic Freestyle bioprostheses demonstrated excellent short-term results for repeat RVOT reconstruction. This valve's hemodynamic characteristics are comparable to those of homografts, and it is an attractive alternative given the limited availability of homograft valves. A lack of availability in sizes smaller than 19 mm limits use of this valve in pediatric patients, and long-term results remain to be determined.
Cook Children's Medical Center, University of North Texas, Fort Worth, Texas 76104, USA. eerez@cookchildrens.org
Eldad
E
Erez
Vincent K H
VK
Tam
Nancy A
NA
Doublin
Jeanie
J
Stakes
D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000601:surgery*; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007902:Length of Stay; D011474:Prosthesis Design; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000503:physiopathology; D011666:Pulmonary Valve Stenosis / Q000209:etiology / Q000503:physiopathology; D012086:Reoperation; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000151:congenital / Q000601:surgery*