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Long‐Term Fate Of Valve Cusp Patches For Right Ventricular Outflow Tract Reconstruction
Author(s) -
OURY JAMES H.,
ANGELL WILLIAM W.
Publication year - 1988
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.1988.tb00447.x
Subject(s) - medicine , pulmonary valve , pulmonary insufficiency , tetralogy of fallot , ventricular outflow tract , cusp (singularity) , cardiology , calcification , pulmonary atresia , ross procedure , pulmonary valve insufficiency , stenosis , cardiac skeleton , surgery , aortic valve , pulmonary artery , pulmonary regurgitation , heart disease , aortic valve replacement , geometry , mathematics
Six patients with tetralogy of Fallot, pulmonary atresia, or absent pulmonary valve syndrome were operated with a RVOT patch containing a single aortic allograft cusp from an adult donor. The method was based on animal work with similar patches implanted in growing puppies and proved that the single cusp functioned as an effective RV outflow valve for several weeks after surgery. Postoperative angiograms in the animals confirmed nearly completely competent valves. Sacrifice of animals at 3 months documented that the allograft tissue was flexible without early deterioration or calcification. Clinical application of this method raised several questions regarding the procedure, its efficacy, and subsequent fate of the allograft valve in children requiring RVOT reconstruction. There were six children age 19 months to 10 years who required division of the pulmonary valve annulus to relieve pulmonary outflow obstruction or with absent pulmonary valve syndrome and compromised airways from pulmonary insufficiency. One patient had a positive culture from the valva and required immediate removal of the infected allograft. Patients had clinically competent pulmonary valves immediately after surgery with decreased right ventricular systolic and end‐diastolic pressures when compared with patients in whom nonvalve patches were inserted. All patients had some degree of pulmonary insufficiency, but no symptoms. Follow‐up up of five patients available 4 to 6 years after surgery revealed no patients with stenosis of the valve cusps, although two patients have severe, one moderate, and two mild pulmonary insufficiency. We conclude that a patch containing a single adult allograft valve cusp should be considered for all patients requiring reconstruction of the RVOT, particularly if RV overload is expected to compromise the immediate postoperative result.