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Stentless porcine valves in the right ventricular outflow tract: improved durability?

^a The Division of Cardiothoracic Surgery, Department of Surgery, Primary Children's Medical Center and The University of Utah, Salt Lake City, UT, USA
^b The Division of Pediatric Cardiology, Department of Pediatrics, Primary Children's Medical Center and The University of Utah, Salt Lake City, UT, USA

Received 1 September 2008; received in revised form 10 December 2008; accepted 15 December 2008.

^_* Corresponding author. Address: Pediatric Cardiothoracic Surgery, Suite 2800, Primary Children's Medical Center, 100 North Mario Capecchi Drive, Salt Lake City, UT 84108, USA. Tel.: +1 801 662 5566; fax: +1 801 662 5571. (Email: john.hawkins{at}hsc.utah.edu).

Objective: Stentless porcine valves are commonly used for aortic valve replacement in adults, yet their long-term performance in the right ventricular (RV) outflow tract is unknown. We evaluated intermediate-term performance of stentless porcine valves in the RV outflow tract in 150 children and adults over a 10-year period. Methods: We retrospectively reviewed data on all patients undergoing placement of a pulmonary valve or RV-PA conduit with a stentless porcine prosthesis (19 mm) from 1998 to 2008. Valvar function was assessed with echocardiography. Freedom from reintervention (explantation or catheter-based intervention) was determined by actuarial methods. Results: A stentless porcine prosthesis was placed in the pulmonary position in 150 patients with a median weight and age of 50.1 kg (range 9.8–127) and 15.8 years (range 1.4–55), respectively. There were three early deaths (2%) and no late deaths. Actuarial freedom from reintervention was 100% at 1 year and 95.5% at 5 years. Peak transvalvar gradient at 1 and 5 years was 13 ± 12 mmHg and 25 ± 11 mmHg, respectively. At last follow-up no patient had severe insufficiency (PI), five patients had moderate PI and the remainder mild or no PI. Conclusions: Stentless porcine valves function well in the pulmonary position over the intermediate-term and are associated with low rates of reintervention in patients requiring a >19 mm valve or valved conduit. Longer-term follow-up and comparison with other alternatives will be necessary to determine if these valves are superior to commonly used allograft or bovine jugular venous valved conduits.

Key Words: Conduit • Pulmonary valve replacement • Stentless porcine valve