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

Correspondence

Reply

Serafin Y. Deleon, MD, Jaime G. Dorotan, MD, Jeffery L. Myers, MD, PhD

Department of Surgery, Tulane University Medical School, 1430 Tulane Ave, SL-22, New Orleans, LA 70112

(E-mail: sdeleon1{at}tulane.edu).

To the Editor:

Although the stented porcine valve in the right ventricular outflow tract had an average longevity of 10 years in our experience [1], we started using the freestyle porcine valve in 1999 with the expectation that it would last longer.

When we reported our experience in 47 patients with the freestyle porcine valve [2], we had 1 patient requiring replacement 1 year postoperatively for obstruction. Two patients were being followed for increasing outflow gradient. Kanter and colleagues [3] reported an even better outcome. However, with time we noticed 5 more patients who had early stenosis develop. We are in the process of reporting these early failures in detail.

In 5 patients who already had reoperation, the conduit was noted to have been completely encased and constricted by a thick fibrous ring. The leaflets were found intact. Retrospective analysis of the preoperative angiogram showed marked reduction of the diameter of the conduit from its original size.

Biologic valves are currently preferred over metallic valves in the right ventricular outflow tract because of the high incidence of thrombosis with the latter valve. Of all the available biologic valves, we felt that the freestyle porcine valve would have been the best. It presumably had better hemodynamics, and because of the anti-calcification treatment, it should last longer. The occurrence of early stenosis from a constricting fibrous ring was a disappointment. However, such a problem is probably not unique with the freestyle porcine valve. All biologic valves without a rigid support such as the homograft and bovine jugular vein conduit could be susceptible to such fibrous constriction in the pulmonary position.

We agree with Erek and colleagues that the freestyle porcine valve is not good in the pulmonary position. We have stopped using the freestyle porcine valve and switched back to the stented porcine valve.


   References
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 References
 

  1. lbawi MN, Idriss FS, Deleon SY, et al. Long term results of porcine valve insertion for pulmonary regurgitation following repair of tetralogy of Fallot Ann Thorac Surg 1986;41:478-482.[Abstract]
  2. 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]
  3. Kanter KR, Fyfe DA, Mahle WT, Forbess JM, Kirshbom PM. Results with freestyle porcine aortic root for right ventricular outflow reconstruction in children Ann Thorac Surg 2003;76:1889-1895.[Abstract/Free Full Text]

Related Article

Durability of Stentless Bioprostheses for Right Ventricular Outflow Tract Reconstruction
Ersin Erek, Yusuf Kenan Yalcinbas, and Tayyar Sarioglu
Ann. Thorac. Surg. 2005 79: 2202-2203. [Extract] [Full Text] [PDF]



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