Right ventricular outflow tract reconstruction with a bovine pericardial monocusp patch: Long-term clinical and hemodynamic evaluation

Abstract

A bovine pericardial monocusp patch was used in 21 patients with a variety of congenital heart defects for reconstruction of obstructed right ventricular outflow tract. Two early postoperative deaths and one late death occurred, and these were unrelated to monocusp patch function. Survivors have completed a mean follow-up of 113 months (range 29 to 141 months). They are all asymptomatic, and their physical activity is unrestricted. Seventeen patients have completed more than 5 years of follow-up and, of these, 11 patients have completed more than 10 years of follow-up. Eleven patients have been reinvestigated by sequential postoperative hemodynamic and angiographic studies at mean periods of 16, 48, and 100 months. The mean peak systolic pressure gradient across the right ventricular outflow tract under conditions of normal flow was 13 +/- 2.4 mm Hg at 16 months, and it has shown no significant change when measured at intervals of up to 124 months after the operation. This lack of change suggests effective long-term relief of the outflow tract obstruction. Serial radiographic screening of all patients and angiographic studies in 11 patients disclosed no evidence of graft calcification, stenosis, or dilatation. The monocusp valve remained functional and effectively abolished or reduced pulmonary valve incompetence. In 11 patients who had residual pulmonary regurgitation, the regurgitation was mild and, up to 12 years after operation, had not resulted in any adverse clinical sequelae.