Performance of bicuspidized pulmonary allografts compared with standard trileaflet allografts.
BACKGROUND
Pulmonary allografts are commonly used in the reconstruction of the right ventricular outflow tract. However, in pediatric patients, allografts that are small enough are often unavailable. To downsize larger, more readily available conduits, one leaflet can be excised, forming a bicuspid valve. The aim of this study was to assess the intermediate-term durability of bicuspidized allografts compared with standard allografts.


METHODS
Forty-seven patients who received a bicuspidized allograft from 1998 to 2008 were compared with 51 patients who received a standard allograft during the same time period. Outcome measures included need for and timing of reintervention, degree of pulmonary stenosis, insufficiency at most recent follow-up, and survival.


RESULTS
On average, the bicuspidized allograft patients were younger, weighed less, and received smaller valves more frequently placed in a heterotopic position than the standard allograft patients. The mean peak gradient across the conduit and the degree of pulmonary insufficiency at discharge were similar between the comparison groups. No statistical differences in need for or timing of reintervention were observed between the surgical groups.


CONCLUSIONS
Bicuspidized allografts performed similarly to that of standard allografts with regard to the need for reintervention, the development of stenosis or regurgitation, and patient survival. Based on this patient sample, the bicuspidized allograft technique appears to provide an excellent option to expand the availability of small-sized allografts for the reconstruction of the right ventricular outflow tract.
Shih
Terry
T
Division of Pediatric Cardiovascular Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA. tyshih@umich.edu
Gurney
James G
JG
Bove
Edward L
EL
Devaney
Eric J
EJ
Hirsch
Jennifer C
JC
Ohye
Richard G
RG
D006348:Cardiac Surgical Procedures / Q000379:methods; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006351:Heart Valves / Q000637:transplantation; D006801:Humans; D008297:Male; D011664:Pulmonary Valve / Q000601:surgery* / Q000637:transplantation; D012189:Retrospective Studies; D013997:Time Factors