THE USE OF BOVINE PERICARDIUM FOR PULMONARY VALVE RECONSTRUCTION OR CONDUIT REPLACEMENT - LONG-TERM CLINICAL FOLLOW-UP

Background and aims of the study: This study aimed to determine the cl inical Performance of bovine pericardial aldehyde-treated material alo ne or in combination with aortic leaflets of porcine origin. These wer e the porcine aortic stentless pulmonary valved bovine pericardial con duit (PSPVC), and porcine aortic monocusp attached to pericardial patc h (PAMC), used to correct right-sided heart lesions. Methods: Between November 1985 and October 1995, 33 patients underwent corrective conge nital surgery with PSPVC. Mean patient age was 5.7 +/- 4.3 years (rang e: 15 days to 18 years). Pulmonary atresia with ventricular septal def ect (VSD) was the most frequent disease (16/33, 48%). For PAMC, 45 pat ients with various congenital heart malformations underwent implantati on between Tune 1989 and April 1996, Mean patient age was 4.8 +/- 4.7 years (range: 2 weeks to 18 years). Results: With PSPVC, hospital mort ality rate was 18.2% and related to poor preoperative clinical conditi on in six cases. Four patients were lost to (f)ollow up; 23 (85%) were followed for 3 months to 10 years (mean 4.8 +/- 3.0 years). Distal an astomotic scarring in four patients was probably clue to retraction of the pericardial tissue. With PAMC, hospital mortality rate was 11% an d related to patients' preoperative clinical condition. Three patients were lost to follow up; 37 survivors have been followed for 6 to 88 m onths (mean 38.5+/-19.0 months). There were no late deaths. Two patien ts underwent reoperation; intraoperative observation showed well-prese rved monocusps with no signs of tissue degeneration. The remaining 35 patients remain asymptomatic by clinical examination and Doppler echoc ardiography. The monocusps remained mobile in every case. Conclusion: PSPVCs have shown excellent performance and durability in young patien ts with a low mean age (5 years). The monocusp graft has remained func tional with good leaflet motion for up to seven years.