title: Sustained Improvement in Right Ventricular Chamber Dimensions 10 Years Following Xenograft Pulmonary Valve Replacement.
abstract: The goals following pulmonary valve replacement (PVR) are to optimize right ventricular hemodynamics and minimize the need for subsequent reoperations on the right ventricular outflow tract. We hypothesized PVR using a xenograft valved conduit would result in superior freedom from reoperation with sustained improvement in right ventricular chamber dimensions.
  
  
  
  Xenograft valved conduits placed in patients aged >16 years were reviewed from 2000 to 2010 to allow for a 5-year minimum follow-up. Preoperative, one-year, and the most recent echocardiograms quantified right ventricular chamber dimensions, corresponding Z scores, and prosthetic valve function. Magnetic resonance imaging (MRI) studies compared preoperative and follow-up right ventricular volumes.
  
  
  
  A total of 100 patients underwent PVR at 24 (19-34) years. Freedom from reintervention was 100% at 10 years. At most recent follow-up, only one patient had greater than mild pulmonary insufficiency. The one-year (17.3 ± 7.2 mm Hg; P < .01) and most recent follow-up (18.6 ± 9.8 mm Hg; P < .01) Doppler-derived right ventricular outflow tract gradients remained significantly lower than preoperative measurements (36.7 ± 27.0 mm Hg). Similarly, right ventricular basal diameter, basal longitudinal diameter, and the corresponding Z scores remained lower at one year and follow-up from preoperative measurements. From 34 MRI studies, the right ventricular end-diastolic indexed volume (161.7 ± 58.5 vs 102.9 ± 38.3; P < .01) and pulmonary regurgitant fraction (38.0% ± 15.9% vs 0.8% ± 3.3%; P < .01) were significantly lower at 7.1 ± 3.4 years compared to the preoperative levels.
  
  
  
  Use of a xenograft valved conduit for PVR results in excellent freedom from reoperation with sustained improvement in right ventricular dimensions at an intermediate-term follow-up.
authors.affiliation: 1 University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Heidi B
authors.initials: HB
authors.lastname: Schubmehl
authors.affiliation: 1 University of Rochester Medical Center, Rochester, NY, USA.|2 Pediatric Cardiac Consortium of Upstate, New York, NY, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Swartz
authors.affiliation: 1 University of Rochester Medical Center, Rochester, NY, USA.|2 Pediatric Cardiac Consortium of Upstate, New York, NY, USA.
authors.forename: Nader
authors.initials: N
authors.lastname: Atallah-Yunes
authors.affiliation: 1 University of Rochester Medical Center, Rochester, NY, USA.|2 Pediatric Cardiac Consortium of Upstate, New York, NY, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Wittlieb-Weber
authors.affiliation: 1 University of Rochester Medical Center, Rochester, NY, USA.|2 Pediatric Cardiac Consortium of Upstate, New York, NY, USA.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Pratt
authors.affiliation: 1 University of Rochester Medical Center, Rochester, NY, USA.|2 Pediatric Cardiac Consortium of Upstate, New York, NY, USA.
authors.forename: George M
authors.initials: GM
authors.lastname: Alfieris
mesh_terms: D000328:Adult; D001705:Bioprosthesis; D002306:Cardiac Volume / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D064593:Heterografts; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D016278:Ventricular Function, Right / Q000502:physiology*; D055815:Young Adult
keywords: MRI; echocardiogram; pulmonary valve; remodeling