Perimount bovine pericardial valve to restore pulmonary valve competence late after right ventricular outflow tract repair.

OBJECTIVE

No ideal option exists for restoring pulmonary valve competence late after repair of the congenitally abnormal right ventricular outflow tract (RVOT). This has driven a continued search for new alternatives. Texas Children's Hospital has recently used the Carpentier-Edwards Perimount RSR Pericardial Aortic Prosthesis (Edwards Lifesciences, Irvine, Calif, USA) for this indication and reports the initial experience.

DESIGN

Retrospective chart review.

SETTING

Academically affiliated tertiary-care pediatric hospital.

PATIENTS: Twenty-six patients who underwent pulmonary valve replacement with the Perimount valve late after RVOT reconstruction between June 2002 and November 2005.

INTERVENTIONS: No prospective interventions.

OUTCOMES MEASURES: Hospital morbidity and mortality. Valve function assessed by follow-up visits and echocardiograms.

RESULTS

Mean age and weight of the patients were 20.3 +/- 9.8 years (range 7.0-45.1 years) and 56.2 +/- 18.1 kg (range 35.8-109 kg). Twenty-two patients (85%) had severe pulmonary insufficiency (PI), 23 (89%) had symptomatic right heart failure, and 14 (54%) had moderate to severe right ventricular dysfunction. Average prosthetic valve size was 23 mm (range 19-27 mm). Twenty-one (88%) patients were extubated within 24 hours. There was no hospital mortality. Median length of stay for all patients from day of surgery was 6 days (range 3-56 days). Median length of last echocardiography follow-up was 12.4 months (range 0.1-37.6 months). At that time, 16 of the 26 (62%) patients had improved right ventricular function, no patient demonstrated significant RVOT obstruction, and 24 patients (92%) have no PI or mild PI. Freedom from death, reintervention, or reoperation on the pulmonary valve is 100% at 2.5 years.

CONCLUSION

Initial results with the Perimount bovine pericardial tissue prosthesis for pulmonary valve replacement are encouraging. Further follow-up is required to define long-term function and durability.