GLUTARALDEHYDE TREATED AUTOLOGOUS PERICARDIUM IN COMPLETE REPAIR OF TETRALOGY OF FALLOT

Pericardium has been used for decades to facilitate the repair of tetr alogy of Fallot (TOF). The impact of glutaraldehyde preserved autologo us pericardium when used as a right ventricular outflow tract (RVOFT) patch in TOF was analyzed in 36 consecutive children undergoing comple te transventricular repair. In 18 (group I) the pericardium was treate d in conventional fashion (harvested and preserved in saline solution) . In the other patients, the pericardium was treated in 0.625% glutara ldehyde solution for 20 minutes and then washed in saline prior to bei ng implanted as an RVOFT patch (group II). The perioperative (prior to hospital discharge) as well as the 6-month postoperative Doppler echo cardiograms were assessed with 100% follow-up. The studies were evalua ted and graded by blinded observers for the presence and severity of a n RVOFT dilatation (+0 to +4) relative to the size of the aortic valve annulus. The age of patients in group I and group II (29 months, 34 m onths) were similar as was the incidence of transannular patching (44% , 41%). Postrepair hemodynamics revealed no significant difference in the right ventricular/left ventricular pressure ratios (42%, 41%) or i n the systolic RVOFT pressure (24 mmHg, 29 mmHg). The predischarge ech ocardiograms showed no outflow tract (OFT) dilation in either group. T here was no morbidity or mortality in either group. At approximately 6 months postoperatively (6.2 mo, 5.7 mo), 72% of group I patients had RVOFT diameters that were larger (+1, +2) than the predischarge diamet ers when reviewed by three observers. In group II there was a single p atient with dilatation of the RVOFT and this graded as +1. The mean RV OFT dilation score in group I was 1.06 (+0.8) versus 0.06 (+0.24) in g roup II (p < 0.05). We conclude that dilute glutaraldehyde preservatio n of autologous pericardium is a safe and effective means of preventin g RVOFT dilatation over the short term in patients in which a hemodyna mically acceptable repair of TOF has been completed.