Outcomes of pericardial bovine xenografts for right ventricular outflow tract reconstruction in children and young adults.

BACKGROUND AND AIM OF THE STUDY: A variety of valve substitutes has been used for right ventricular outflow tract (RVOT) reconstruction in children and young adults following previous RVOT surgery that has led to significant pulmonary insufficiency and/or stenosis. Herein, the authors' experience with pulmonary valve replacement (PVR) using a stented bovine pericardial xenograft late after previous RVOT surgery was reviewed.

METHODS

Between 2000 and 2011, a total of 49 patients (mean age 22.4 +/- 12.3 years; range: 5-50 years) underwent PVR using stented bovine pericardial xenografts. All patients had prior RVOT reconstruction; these patients averaged two prior operations (range: 1-4) for the following diagnoses: tetralogy of Fallot (n = 28), pulmonary atresia (n = 6), pulmonary stenosis (n = 6), transposition of the great arteries (n = 3), truncus arteriosus (n = 1), and others (n = 5). Of these patients, 24 (49%) underwent additional procedures at the time of pulmonary valve insertion.

RESULTS

There was no early death, but six late deaths. The overall survival rate was 88% at 10 years. All surviving patients were well at a mean follow up of 4.0 +/- 2.3 years (range: 6 months to 10 years). Echocardiography showed trivial or no pulmonary insufficiency in 22 patients (56%). The calculated mean peak systolic RVOT gradient at the last follow up by echocardiography was 22.7 +/- 6.6 mmHg. Freedom from RVOT reintervention and xenograft explantation was 94% and 98% at 10 years, respectively.

CONCLUSION

The stented bovine pericardial xenografts demonstrated excellent intermediate-term results for repeat RVOT reconstruction. The hemodynamic characteristics of this valve are comparable to those of allografts, and the xenograft represents is an attractive alternative given the limited availability of allografts. The stented bovine pericardial xenograft remains an ideal valve choice for teenagers and young adults with congenital abnormalities of the RVOT, especially for redo as a second or third choice.