Early and midterm results of valved conduits used in right ventricular outflow tract reconstruction

Abstract

Background: In this article, we present early and midterm results of patients who underwent right ventricular outflow tract (RVOT) reconstructions using different types of valved xenografts. Methods: Between July 2002 and December 2010, 56 patients (33 males, 23 females; mean age 3.7 years; range 1 month-19 years) who underwent RVOT reconstructions using different types of valved xenografts were included. The mean size of the valved conduits was 16.5 mm (range 11-23 mm). Regarding different types of valved conduits; porcine aortic valve implanted bovine pericardial conduit (LabCor, Sulzer Carbomedics), bovine valved jugular vein (Contegra, Medtronic), glutaraldehyde fixed porcine aortic valved root (Freestyle, Medtronic) and bovine pericardial tube containing stentless porcine pulmonary valve were used in 41, 13, one and one patients, respectively. Results: Eight patients (14.2%) died in early postoperative period and one patient (1.8%) died in late postoperative period. Conduit stenoses were encountered in 15 patients (31.9%) through the follow-up with a mean of 22.5 months (range 1 month to 6 years). Among the patients with conduit stenosis, mild stenosis was present in 10 (21.2%) (mean gradient 26.5 mmHg), moderate in two (4.2%) (mean gradient 42 mmHg) and severe in three patients (6.3%) (mean gradient 66.6 mmHg). Percutaneous balloon angioplasty was performed in patients with severe conduit stenosis. Following balloon angioplasty, right ventricle (RV)-pulmonary artery (PA) stenosis gradients decreased to 33-37 mmHg in two patients. Intraconduit stent implantation was required in one patient with a RV-PA gradient of 50 mmHg following balloon angioplasty (residual stenosis gradient 30 mmHg). Conclusion: Valved xenografts seem to be alternatives to pulmonary homografts to be used in RVOT reconstructions. Long-term durability of these conduits should be supported with further studies.