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Ann Thorac Surg 2005;79:2202-2203
© 2005 The Society of Thoracic Surgeons

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Correspondence

Durability of Stentless Bioprostheses for Right Ventricular Outflow Tract Reconstruction

Acibadem Bakirkoy Hospital, Halit Ziya Usakligil cad. No. 1 BaKirkoy Istanbul, 34140, Turkey

(E-mail: ersinerek{at}hotmail.com).

To the Editor:

We read with great interest the articles by Hartz [1], Kanter [2], and their colleagues summarizing their results with Medtronic Freestyle porcine aortic bioprostheses for right ventricular outflow tract (RVOT) reconstruction. Both groups stated that there was no increase in transvalvular gradients at a mean of 16 months [1] or 2.5 years [2] postoperatively. We agree with the suitability of stentless bioprostheses for RVOT reconstruction, but our data do not confirm their findings regarding durability of these conduits.

Between March 1996 and August 1999, we [3] used Medtronic Freestyle porcine aortic conduits in 27 patients for RVOT reconstruction. We observed a significant increase in peak transvalvular gradients at 20.9 ± 17.1 months of follow-up (9.1 ± 3.3 mm Hg versus 34 ± 17.6 mm Hg; p = 0.0015). Therefore, since August 1999, we have been looking for better alternatives. We began to use CryoLife Ross pulmonary heterografts (n = 15) and Medtronic Contegra pulmonary valved conduits (bovine jugular vein with a trileaflet venous valve) (n = 9). However, we have seen similar increases in transvalvular gradients with these grafts at midterm follow-up. To date, 6 patients have had a reoperation because of conduit stenosis (Medtronic Freestyle, n = 4; CryoLife Ross, n = 2). Mean time to reoperation was 48.1 ± 8.5 months (range, 36 to 60 months). At reoperation, all conduits were severely calcified (Fig 1).

View larger version (116K): [in this window] [in a new window]   Fig 1. Chest roentgenogram made 53 months postoperatively showing calcified Medtronic Freestyle conduit.

	References

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1. Hartz RS, Deleon SY, Lane J, et al. Medtronic Freestyle valves in right ventricular outflow tract reconstruction Ann Thorac Surg 2003;76:1896-1900.[Abstract/Free Full Text]
2. Kanter KR, Fyfe DA, Mahle WT, Forbess JM, Kirshbom PM. Results with the Freestyle porcine aortic root for right ventricular outflow tract reconstruction in children Ann Thorac Surg 2003;76:1889-1895.[Abstract/Free Full Text]
3. Erek E, Yalcinbas YK, Salioglu E, et al. Fate of stentless bioprostheses on right side of the heart Asian Cardiovasc Thorac Ann 2003;11:58-62.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ersin Erek Yusuf Kenan Yalcinbas Tayyar Sarioglu Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Erek, E. Articles by Sarioglu, T. Search for Related Content PubMed Articles by Erek, E. Articles by Sarioglu, T. Related Collections Congenital - acyanotic Related Articles