The Stentless Porcine Aortic Root for Reconstruction of Right Ventricular Outflow Tract

Abstract

There are various congenital cardiac diseases that require repeat reconstruction of the right ventricular outflow tract (RVOT). Several options are available for RVOT reconstruction. We present the technique of utilizing the stentless porcine aortic root (Prima; Edwards Lifesciences, Irvine, CA; Freestyle; Medtronic, Minneapolis, MN) for RVOT reconstruction. The porcine aortic root was initially developed for replacement and reconstruction of the aortic root. However, it was subsequently recognized to be versatile enough for RVOT reconstruction. 1 There are 2 commercially available porcine aortic roots, the Freestyle (available in diameters 19‐29 mm) and Prima (available in diameters 21‐29 mm). WeroutinelyusetheFreestyle19-mmconduit,andPrimafor all other size conduits larger than 19 mm. Patients with tetralogy of Fallot, truncus arteriosus, as well as those undergoingaRossprocedure,arecandidatesforthisconduit.Itcan be used for replacement of stenotic and calcified conduits, and also to provide a competent pulmonary valve in the RVOT position in patients who have had a previous transannular patch. We use published nomograms to determine the size of pulmonary valve required by body surface area and then try to upsize it up to a Z-score 2 (range 1t o 3). We do not upsize it larger than a Z-score 3 because this has the potential for sternal compression and valve failure. 2 The reoperative techniques are standardized. We obtain preoperative echocardiogram and either a cardiac catheterization or a magnetic resonance imaging scan. These studies help us determine any additional procedures that might need to be done at the time of the conduit replacement. The groin vesselsarealsoevaluatedwithduplexstudies.Thepositionof the current conduit in relationship to the sternum is also noted.