title: Long-Term Survival and Freedom From Reoperation After Placement of a Pulmonary Xenograft Valved Conduit.
abstract: BACKGROUND
  The optimal choice for pulmonary valve replacement (PVR) remains controversial. This study hypothesized that xenografts used for PVR would result in prolonged long-term survival and freedom from reoperation.
  
  
  METHODS
  Children and adults with congenital heart disease requiring PVR using a xenograft from 1980 to 1985 were reviewed. In all cases, the xenograft valve was either sewn or manufactured into a Dacron conduit, and the conduit was sewn to the pulmonary artery bifurcation. Clinical data were analyzed, and survival and freedom from reoperation were determined using Kaplan-Meier analysis.
  
  
  RESULTS
  Twenty-four patients received a xenograft for PVR at 14.6 ± 5.6 years. Conduit size ranged from 21 to 27 mm. Most patients received a Carpentier-Edwards valved conduit (n = 17), followed by a Hancock valved conduit (n = 5) and an Ionescu-Shiley valve sewn into a Dacron graft (n = 2). No perioperative deaths occurred. Reoperation was required mainly for pulmonary stenosis (72.7%), followed by pulmonary insufficiency (18.2%), or both stenosis and insufficiency (9%). Freedom from reoperation was 90%, 56%, 43%, and 14% at 10, 20, 25, and 30 years, respectively. At most recent follow-up the was only death, which was related to severe biventricular failure 25 years after conduit implant.
  
  
  CONCLUSIONS
  PVR using a xenograft valved conduit results in prolonged freedom from reoperation and excellent long-term survival. These data, which provide long-term follow-up information on xenograft valves after PVR.
authors.affiliation: Department of Surgery, University of Rochester Medical Center, Rochester, New York. Electronic address: george_alfieris@urmc.rochester.edu.
authors.forename: George M
authors.initials: GM
authors.lastname: Alfieris
authors.affiliation: Department of Surgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Swartz
authors.affiliation: Department of Surgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Juan
authors.initials: J
authors.lastname: Lehoux
authors.affiliation: Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Bove
mesh_terms: D000293:Adolescent; D001705:Bioprosthesis; D006328:Cardiac Catheterization; D002648:Child; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D064593:Heterografts; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013996:Time and Motion Studies; D014481:United States / Q000453:epidemiology