Invited Commentary

Abstract

Invited commentaryValved conduits of all types (homograft or xenograft) have an accelerated failure rate in the smaller sizes used for the repair of complex congenital heart defects in infants and small children. These investigators examined the use of an unstented xenograft in the pulmonary position and compared the outcomes to a matched historic control group of patients receiving pulmonary homograft valves. The patient groups are small and the follow-up of the xenograft patients is relatively short. Despite the limitations of the study, the results are clearcut. The unstented xenograft used in this report did not fare as well as the current gold standard, the pulmonary homograft.The high early failure rate of the unstented xenograft in this small series is disappointing. However, these investigators are to be commended for their attempt to find an alternative prosthesis for use in the repair of infants and children requiring a conduit between the right ventricle and the pulmonary arteries. Although the requirement for a valve in the conduit between the right ventricle and the pulmonary artery is debatable in some situations, most surgeons agree that the majority of patients will benefit from a competent pulmonary valve both early and late after the repair of a complex defect. Congenital heart surgeons must continue to investigate the use of alternative conduits until a more durable, less expensive valved conduit for use in infants and small children is discovered. Invited commentaryValved conduits of all types (homograft or xenograft) have an accelerated failure rate in the smaller sizes used for the repair of complex congenital heart defects in infants and small children. These investigators examined the use of an unstented xenograft in the pulmonary position and compared the outcomes to a matched historic control group of patients receiving pulmonary homograft valves. The patient groups are small and the follow-up of the xenograft patients is relatively short. Despite the limitations of the study, the results are clearcut. The unstented xenograft used in this report did not fare as well as the current gold standard, the pulmonary homograft.The high early failure rate of the unstented xenograft in this small series is disappointing. However, these investigators are to be commended for their attempt to find an alternative prosthesis for use in the repair of infants and children requiring a conduit between the right ventricle and the pulmonary arteries. Although the requirement for a valve in the conduit between the right ventricle and the pulmonary artery is debatable in some situations, most surgeons agree that the majority of patients will benefit from a competent pulmonary valve both early and late after the repair of a complex defect. Congenital heart surgeons must continue to investigate the use of alternative conduits until a more durable, less expensive valved conduit for use in infants and small children is discovered. Valved conduits of all types (homograft or xenograft) have an accelerated failure rate in the smaller sizes used for the repair of complex congenital heart defects in infants and small children. These investigators examined the use of an unstented xenograft in the pulmonary position and compared the outcomes to a matched historic control group of patients receiving pulmonary homograft valves. The patient groups are small and the follow-up of the xenograft patients is relatively short. Despite the limitations of the study, the results are clearcut. The unstented xenograft used in this report did not fare as well as the current gold standard, the pulmonary homograft. The high early failure rate of the unstented xenograft in this small series is disappointing. However, these investigators are to be commended for their attempt to find an alternative prosthesis for use in the repair of infants and children requiring a conduit between the right ventricle and the pulmonary arteries. Although the requirement for a valve in the conduit between the right ventricle and the pulmonary artery is debatable in some situations, most surgeons agree that the majority of patients will benefit from a competent pulmonary valve both early and late after the repair of a complex defect. Congenital heart surgeons must continue to investigate the use of alternative conduits until a more durable, less expensive valved conduit for use in infants and small children is discovered.