title: Medium-term outcomes after pulmonary valve replacement with the Freestyle valve for congenital heart disease: a case series.
abstract: OBJECTIVE
  The Freestyle valve may be used for pulmonary valve replacement (PVR). Whether its stentless design and anticalcification treatment improve durability relative to alternative bioprostheses, however, is unknown and long-term data are lacking.
  
  
  METHODS
  We performed a retrospective review of all Freestyle PVRs performed by a single surgeon in two institutions. All patients were contacted for follow-up to establish survival, New York Heart Association class and reintervention. Up to date, echocardiography was obtained to assess valve function. Perioperative factors associated with structural valve dysfunction (SVD) were assessed using Cox regression.
  
  
  RESULTS
  Between 2000 and 2014, PVR with a Freestyle valve was performed in 114 patients with congenital heart disease. There were 70 males and 44 females. The median age was 21 years (interquartile range 11-35 years). The median clinical and echocardiographic follow-up was 62 months (interquartile range 35-115 months, n = 110) and 58 months (interquartile range 30-93 months, n = 107), respectively. Follow-up was complete for 107 of 114 patients (94%). The survival rate was 95% at 5 years and 91% at 10 years. The rate of freedom from SVD at 5 years was 82%, and at 10 years was 61%. The reintervention-free survival rate was 85% at 5 years, and 71% at 10 years.
  
  
  CONCLUSIONS
  The Freestyle valve in the pulmonary position in a congenital population is associated with low medium-term incidences of SVD and reintervention. It performs equally well to the homograft when a conduit is required and can be considered a valid alternative to stented bioprostheses when PVR alone is required.
authors.affiliation: Department of Cardiothoracic Surgery, Western Australia Cardiothoracic Research and Audit Group, Fiona Stanley Hospital, Perth, WA, Australia bdunne14784@gmail.com.
authors.forename: Ben
authors.initials: B
authors.lastname: Dunne
authors.affiliation: Department of Cardiothoracic Surgery, Western Australia Cardiothoracic Research and Audit Group, Fiona Stanley Hospital, Perth, WA, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Suthers
authors.affiliation: Department of Cardiothoracic Surgery, Western Australia Cardiothoracic Research and Audit Group, Fiona Stanley Hospital, Perth, WA, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Xiao
authors.affiliation: Department of Health WA, Public Health and Clinical Services Division, Perth, WA, Australia.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Department of Cardiothoracic Surgery, Western Australia Cardiothoracic Research and Audit Group, Fiona Stanley Hospital, Perth, WA, Australia Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
authors.forename: Edward
authors.initials: E
authors.lastname: Litton
authors.affiliation: Department of Cardiothoracic Surgery, Western Australia Cardiothoracic Research and Audit Group, Fiona Stanley Hospital, Perth, WA, Australia Department of Cardiac Surgery, Princess Margaret Hospital, Perth, WA, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Andrews
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011664:Pulmonary Valve / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: CHD; Pulmonary valve; Right ventricle; Tetralogy of Fallot; Valve