title: Pulmonary-Valve Replacement in Adults: Results With the Medtronic Freestyle Valve.
abstract: BACKGROUND
  We used the Medtronic Freestyle valve (Medtronic, Minneapolis, MN) as an orthotopic conduit in pulmonary valve replacement in repaired tetralogy of Fallot and as part of the Ross procedure. Midterm outcomes and hemodynamic status of this conduit were analyzed and performances in both subgroups were compared.
  
  
  METHODS
  From February 2002 to July 2012, 115 Freestyle valves were implanted in 52 patients with tetralogy of Fallot and 63 patients within the Ross procedure. Preoperative and perioperative data were reviewed retrospectively in this bicentric study.
  
  
  RESULTS
  Mean age at valve surgery was 37 ± 13 years. Median implanted valve size was 27 mm (21 to 29). Early postoperative mortality was 3.48%. There was 100% follow-up for the survivors at a mean of 4.38 ± 2.52 years. There was 1 case of thromboembolism (0.89%), 6 endocarditis (5.4%), and 9 (7.8%) conduit re-interventions. Echocardiography at discharge and last follow-up showed average peak systolic transvalvular gradients of 12.4 ± 5.1 and 18.7 ± 8.8 mm Hg, respectively. Ten patients had significant proximal anastomotic gradients of greater than 50 mm Hg and 4 moderate conduit regurgitations. Survival was 96.52%. No valve degeneration was seen in 87.82% at 5 years. The only risk factor identified for valve re-intervention was conduit implantation without infundibular hood (p = 0.01 in multivariate analysis).
  
  
  CONCLUSIONS
  Mid-term data show that Freestyle valves are well suited for pulmonary valve replacement in adults in both categories. The surgical technique used in valve implantation is important to ensure conduit durability. These results and accessibility to the Freestyle valve make this an acceptable alternative to homografts.
authors.affiliation: Department of Cardiovascular Surgery, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France.
authors.forename: Sowmya
authors.initials: S
authors.lastname: Ramanan
authors.affiliation: Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Doll
authors.affiliation: Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Boethig
authors.affiliation: Department of Cardiac Anesthesiology, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France.
authors.forename: Nadir
authors.initials: N
authors.lastname: Tafer
authors.affiliation: Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Horke
authors.affiliation: Department of Cardiovascular Surgery, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Roques
authors.affiliation: Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany.
authors.forename: Wolfgang Bruno
authors.initials: WB
authors.lastname: Hemmer
authors.affiliation: Department of Cardiovascular Surgery, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France. Electronic address: francois.roubertie@chu-bordeaux.fr.
authors.forename: François
authors.initials: F
authors.lastname: Roubertie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000601:surgery*; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult