Long-Term Survival and Freedom From Reoperation After Placement of a Pulmonary Xenograft Valved Conduit

Abstract

The optimal choice for pulmonary valve replacement (PVR) remains controversial. This study hypothesized that xenografts used for PVR would result in prolonged long-term survival and freedom from reoperation. Children and adults with congenital heart disease requiring PVR using a xenograft from 1980 to 1985 were reviewed. In all cases, the xenograft valve was either sewn or manufactured into a Dacron conduit, andthe conduit was sewn to the pulmonary artery bifurcation. Clinical data were analyzed, and survival and freedom from reoperation were determined using Kaplan-Meier analysis. Twenty-four patients received a xenograft forPVR at 14.6 ± 5.6 years. Conduit size ranged from 21to 27mm. Most patients received a Carpentier-Edwards valved conduit (n= 17), followed by a Hancock valved conduit (n= 5) and an Ionescu-Shiley valve sewn into aDacron graft (n= 2). No perioperative deaths occurred. Reoperation was required mainly for pulmonary stenosis (72.7%), followed by pulmonary insufficiency (18.2%), or both stenosis and insufficiency (9%). Freedom from reoperation was 90%, 56%, 43%, and14% at 10, 20, 25, and 30 years, respectively. At mostrecent follow-up the was only death, which was related to severe biventricular failure 25 years after conduit implant. PVR using a xenograft valved conduit results in prolonged freedom from reoperation and excellent long-term survival. These data, which provide long-term follow-up information on xenograft valves after PVR.