title: Stentless porcine valves in the right ventricular outflow tract: improved durability?
abstract: OBJECTIVE
  Stentless porcine valves are commonly used for aortic valve replacement in adults, yet their long-term performance in the right ventricular (RV) outflow tract is unknown. We evaluated intermediate-term performance of stentless porcine valves in the RV outflow tract in 150 children and adults over a 10-year period.
  
  
  METHODS
  We retrospectively reviewed data on all patients undergoing placement of a pulmonary valve or RV-PA conduit with a stentless porcine prosthesis (>/=19 mm) from 1998 to 2008. Valvar function was assessed with echocardiography. Freedom from reintervention (explantation or catheter-based intervention) was determined by actuarial methods.
  
  
  RESULTS
  A stentless porcine prosthesis was placed in the pulmonary position in 150 patients with a median weight and age of 50.1 kg (range 9.8-127) and 15.8 years (range 1.4-55), respectively. There were three early deaths (2%) and no late deaths. Actuarial freedom from reintervention was 100% at 1 year and 95.5% at 5 years. Peak transvalvar gradient at 1 and 5 years was 13+/-12 mmHg and 25+/-11 mmHg, respectively. At last follow-up no patient had severe insufficiency (PI), five patients had moderate PI and the remainder mild or no PI.
  
  
  CONCLUSIONS
  Stentless porcine valves function well in the pulmonary position over the intermediate-term and are associated with low rates of reintervention in patients requiring a >19 mm valve or valved conduit. Longer-term follow-up and comparison with other alternatives will be necessary to determine if these valves are superior to commonly used allograft or bovine jugular venous valved conduits.
authors.affiliation: The Division of Cardiothoracic Surgery, Department of Surgery, Primary Children's Medical Center and The University of Utah, Salt Lake City, UT, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Hawkins
authors.forename: Christopher Todd
authors.initials: CT
authors.lastname: Sower
authors.forename: Linda M
authors.initials: LM
authors.lastname: Lambert
authors.forename: Peter C
authors.initials: PC
authors.lastname: Kouretas
authors.forename: Phillip T
authors.initials: PT
authors.lastname: Burch
authors.forename: Aditya K
authors.initials: AK
authors.lastname: Kaza
authors.forename: Michael D
authors.initials: MD
authors.lastname: Puchalski
authors.forename: Angela T
authors.initials: AT
authors.lastname: Yetman
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D011664:Pulmonary Valve / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000601:surgery; D012189:Retrospective Studies; D034421:Sus scrofa; D013771:Tetralogy of Fallot / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult