Stentless porcine valves in the right ventricular outflow tract: improved durability?☆

Hawkins, John A.; Sower, Christopher T.; Lambert, Linda M.; Kouretas, Peter C.; Burch, Phillip T.; Kaza, Aditya K.; Puchalski, Michael D.; Yetman, Angela T

doi:10.1016/j.ejcts.2008.12.028

Cited by 31 publications

(16 citation statements)

References 19 publications

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“…This is lower than what was observed by Dunne and colleagues, who reported pulmonary insufficiency in 12.5% of cases of structural valve dysfunction and mixed stenosis and insufficiency in an additional 16.7%. Hawkins et al reported low reintervention rate at five years (4/150 patients, 2.6%) for a similar aortic root bioprosthesis and all were due to stenosis. Of their remaining patients at five‐year follow‐up, only five patients had moderate insufficiency with the remainder having none to mild insufficiency.…”

Section: Discussionmentioning

confidence: 98%

“…To our knowledge, this is the largest cohort of primarily pediatric patients undergoing RVOTR using the Freestyle porcine aortic root heterograft and our findings demonstrate good outcomes. Previous studies have demonstrated that porcine aortic valves in the non‐Ross population perform well in the short term and intermediate term . Dunne and colleagues reported their experience with 114 patients with a median age of 21 years.…”

Section: Discussionmentioning

confidence: 99%

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Midterm outcomes of right ventricular outflow tract reconstruction using the Freestyle xenograft

Kuo

Hamby

Munawar

et al. 2019

Congenital Heart Disease

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Objective Various options exist for right ventricular outflow tract (RVOT) reconstruction in congenital heart disease. The Freestyle porcine aortic root may be used but its longevity is not well defined. Design We performed a retrospective review of all non‐Ross RVOT reconstructions using the Freestyle root in our institution. Survival and reintervention, either by surgery, transcatheter valve implantation, balloon valvuloplasty, or bare metal stent placement, were recorded. Factors associated with reintervention were assessed using Cox regression. Results Between January 2002 and December 2015, there were 182 patients identified. Sixteen patients were lost to follow‐up and 3 patients died, unrelated to cardiac surgery. Of the remaining 163 patients, the median age was 12.2 years (interquartile range 6.4‐16.4), median weight was 39.0 kg (interquartile range 19.9‐59.3), and the median body surface area was 1.23 m2 (interquartile range 0.79‐1.64). Ninety‐three (57%) patients had tetralogy of Fallot. The median follow‐up was 5.4 years (interquartile range 2.9‐8 years). There were no operative or cardiac‐related deaths. Thirty‐eight patients (23%) required reintervention. The rate of freedom from reintervention was 93.2% (95% CI 86.7%‐96.6%) at 5 years and 48.4% (95% CI 34.9%‐60.6%) at 10 years. Age < 10 years, weight < 39 kg, and body surface area <1.2 m2 at the time of valve placement, as well as valve size ≤25 mm were significantly associated with need for earlier reintervention. Conclusions The Freestyle root in the RVOT is associated with excellent survival and low midterm need for reintervention. Its longevity is comparable to published data on homografts and other bioprosthetic valves.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Midterm outcomes of right ventricular outflow tract reconstruction using the Freestyle xenograft

Kuo

Hamby

Munawar

et al. 2019

Congenital Heart Disease

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“…1 Although PVR in repaired TOF represents in adults a frequent surgical procedure of the RVOT, surgical management of an associated tricuspid regurgitation (TR), which is observed in up to 30% of patients, remains debated. [2][3][4] Indeed, only scarce data on the surgical management of TR at the time of PVR have been published so far, with controversial results. [5][6][7][8] In these adult patients with repaired TOF who underwent PVR, we sought to (1) determine factors that predispose to the development of significant preoperative TR and (2) evaluate the efficacy of a concomitant tricuspid valve (TV) repair at the time of PVR.…”

Section: See Editorial Commentary Page 224mentioning

confidence: 99%

Tricuspid valve repair and pulmonary valve replacement in adults with repaired tetralogy of Fallot

Roubertie

Séguéla

Jalal

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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“…Most patients receive a bio-prosthesis such as a homograft or heterograft, either stented or un-stented. [10][11][12] All of these valves are non-living and non-repairable, and share a common durability issue. They undergo a biodegenerative process and ultimately will fail with obstruction and/or insufficiency over time.…”

Section: T He Need For Pulmonary Valve Replacementmentioning

confidence: 99%

Polytetrafluoroethylene pulmonary valve conduit implantation for chronic pulmonary insufficiency

Quintessenza

2014

Cardiol Young

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Pulmonary valve replacement in patients with congenital cardiac disease is now being performed with more liberal indications in light of the data that chronic pulmonary insufficiency is not a benign lesion. The beneficial effects of valve replacement with low operative mortality and morbidity support this approach. Many options exist for a pulmonary valve prosthesis, which underscores the fact that there is no ideal valve available. Our efforts are focussed around a synthetic valve that avoids the bio-degeneration of a bio-prosthesis and avoids the need for life-long coumadin. We developed a bicuspid (bileaflet) polytetrafluoroethylene valve design, which has now gone through three major revisions in >200 patients over 14 years. We began the experience utilising a polytetrafluoroethylene hand-sewn bicuspid valve in the right ventricular outflow tract, initially using 0.6 mm and more recently 0.1 mm polytetrafluoroethylene. The 0.1 mm thickness material functions well as a leaflet, maintaining a relatively thin and flexible nature. It does not calcify or initiate thromboses at least for the first several years. We identified issues with dehiscence of the leaflet from the right ventricular outflow tract muscle, especially in the larger, potentially expansive right ventricular outflow tracts, and this prompted our latest design change to place the valve within a polytetrafluoroethylene tube. This current version of the polytetrafluoroethylene valve conduit has excellent short-to-intermediate-term function. Further follow-up is necessary to determine late durability and life-long valve-related procedural risk for our patients.

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Stentless porcine valves in the right ventricular outflow tract: improved durability?☆

Cited by 31 publications

References 19 publications

Midterm outcomes of right ventricular outflow tract reconstruction using the Freestyle xenograft

Midterm outcomes of right ventricular outflow tract reconstruction using the Freestyle xenograft

Tricuspid valve repair and pulmonary valve replacement in adults with repaired tetralogy of Fallot

Polytetrafluoroethylene pulmonary valve conduit implantation for chronic pulmonary insufficiency

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