Assessment of untreated fresh autologous pericardium as material for construction of heart valve: Result at 5 years

Abstract

Introduction: Tetralogy of Fallot requiring transannular repair of the right ventricular outflow tract (RVOT) are exposed to free pulmonary insufficiency and hence inevitable right ventricular dysfunction. This study analyzes the function and structure of untreated autologous pericardium monocusp used to create a competent pulmonary valve. Materials and Methods: This is a retrospective analysis of 52 cases operated between December 2006 and December 2012. Untreated autologous pericardium was used for creating a competent pulmonary valve following a transannular patch. They are followed for functional and structural assessment of the pulmonary valve by echocardiography. Positron emission tomography (PET) with 18 fluorodeoxyglucose was performed in two cases for profiling the pulmonary valve. Results: Median age was 10.5 years (1–38). The follow-up was complete for 42 (80.76%) patients for 3 years and 25 (48.07%) patients for 5 years. The RVOT gradient was 42 mmHg (16–96) in the year of surgery, which reduced to 26 mmHg (10–58) and pulmonary insufficiency that was present in 8.3% of patients in 1 st year was witnessed in 22.7% in the 5 th year of follow-up. The monocusp patch was successful in creating a competent valve while maintaining its structure at 3 years; however, it became distorted and retracted at 5 years of follow-up. There was no calcification in any of the patients. PET-computed tomography confirmed the uptake of glucose by monocusp at 1 year of follow-up. Conclusion: The untreated autologous pericardium functioned well when it was used to create a competent pulmonary valve at short term and midterm. Although it changed in its structure; there was no calcification at 5 years of follow-up.

Hemodynamic evaluation of biomaterial-based surgery for Tetralogy of Fallot using a biorobotic heart, in silico, and ovine models

“…This system can also potentially be used to explore the impact of various designs of monocusp valves and surgical procedures on clinical outcomes. Furthermore, these platforms can be used with different valve materials, including biologic homograft patches, for example, autologous pericardium ( 41 ), and could be adapted to study other geometrically complex RVOT interventions, such as the design of RV to PA conduits ( 42 ). Although the in silico surgical geometry in the presented work assumed a zero initial stress and strain state, the proposed computational framework could include an inverse step solution to calculate the actual stress state caused by the incision.…”

Transannular patch repair of tetralogy of Fallot with or without monocusp valve reconstruction: a meta-analysis

“…Transannular patch (TAP) repair is one of the most effective approaches to enlarge the ROVT when the narrowed pulmonary annulus is insufficient to warrant a total correction [ 3 ]. This procedure includes an incision to the annulus of a malformed valve, and enlargement of the infundibulum and main pulmonary artery with a TAP [ 4 ], which is commonly performed when the RVOT is severely narrowed.…”

Transannular Patch Repair of Tetralogy of Fallot With or Without Monocusp Valve Reconstruction: A Meta-analysis

“…2 Transannular patch (TAP) repair is one of the most effective approaches to enlarge the ROVT when the narrowed pulmonary annulus is insu cient to warrant a total correction. 3 This procedure includes an incision to the annulus of a malformed valve, and enlargement of the infundibulum and main pulmonary artery with a TAP, 4 which is commonly performed when the RVOT is severely narrowed. The most obvious advantage of a TAP is that it can resolve right ventricular hypertension immediately.…”