Midterm outcomes of right ventricular outflow tract reconstruction using the Freestyle xenograft

Abstract

Objective Various options exist for right ventricular outflow tract (RVOT) reconstruction in congenital heart disease. The Freestyle porcine aortic root may be used but its longevity is not well defined. Design We performed a retrospective review of all non‐Ross RVOT reconstructions using the Freestyle root in our institution. Survival and reintervention, either by surgery, transcatheter valve implantation, balloon valvuloplasty, or bare metal stent placement, were recorded. Factors associated with reintervention were assessed using Cox regression. Results Between January 2002 and December 2015, there were 182 patients identified. Sixteen patients were lost to follow‐up and 3 patients died, unrelated to cardiac surgery. Of the remaining 163 patients, the median age was 12.2 years (interquartile range 6.4‐16.4), median weight was 39.0 kg (interquartile range 19.9‐59.3), and the median body surface area was 1.23 m2 (interquartile range 0.79‐1.64). Ninety‐three (57%) patients had tetralogy of Fallot. The median follow‐up was 5.4 years (interquartile range 2.9‐8 years). There were no operative or cardiac‐related deaths. Thirty‐eight patients (23%) required reintervention. The rate of freedom from reintervention was 93.2% (95% CI 86.7%‐96.6%) at 5 years and 48.4% (95% CI 34.9%‐60.6%) at 10 years. Age < 10 years, weight < 39 kg, and body surface area <1.2 m2 at the time of valve placement, as well as valve size ≤25 mm were significantly associated with need for earlier reintervention. Conclusions The Freestyle root in the RVOT is associated with excellent survival and low midterm need for reintervention. Its longevity is comparable to published data on homografts and other bioprosthetic valves.

Two Decades Using Stentless Porcine Aortic Root in Right Ventricular Outflow Tract Reconstruction

“…Other studies report similar rates of freedom from re-intervention at 5 years: 95.5% (Hawkins et al), 93.2% (Kuo et al), and 85% (Dunne et al). 2,4,7 However, the results of our study dramatically diverge from the literature at 10 years with rates of freedom from re-intervention dropping to 71% (Dunne et al), 48.4% (Kuo et al), and 31.2% (Lee et al). 4,7,12 One possible explanation for this difference is patient age at the time of operation.…”

“…2,4,7 However, the results of our study dramatically diverge from the literature at 10 years with rates of freedom from re-intervention dropping to 71% (Dunne et al), 48.4% (Kuo et al), and 31.2% (Lee et al). 4,7,12 One possible explanation for this difference is patient age at the time of operation. While the median age of the above studies ranged from 12.2 to 21 years, the median age of our patients was 32.4 years, with the youngest patient being 18 years of age.…”

“…Despite this added difficulty with surgical placement of the stentless porcine aortic root, numerous studies have demonstrated excellent short-to-medium term outcomes and rates of endocarditis ranging from 0-5%. [2][3][4][5][6][7] In this study, we aimed to evaluate medium-to-long term outcomes including valve durability and need for re-intervention following stentless porcine PVR for older adolescent and adult patients at our institution.…”

Seven decades of valved right ventricular outflow tract reconstruction: The most common heart procedure in children

“…Porcine aortic roots have demonstrated excellent freedom from reintervention up to 10 years, although results may be inferior in patients younger than 10 years. 15,16 Similar outcomes between stentless and stented bioprostheses have been observed up to 10 years post-implantation. 5,17,18 In 116 patients who underwent Freestyle PVR between 1998 and 2018, the 10-year freedom from reintervention was 94%, with only 2 suspected cases of endocarditis, neither of which required reintervention (Kasten MW, Herrmann JL, Brown JW, et al, unpublished data, 1998.…”

Surgical Considerations for Treatment of Fungal Homograft Endocarditis in Re-re-re-re-do

“…Medtronic Freestyle prosthesis was chosen due to promising results when implanted into the RVOT as part of a congenital heart surgery. 4 The origins of the coronary arteries were sutured and positioned ventrally to avoid graft kinking. For the same reason, an additional bovine patch was interposed between the upper margin of the prosthesis and the pulmonary bifurcation.…”