Reconstruction of the pulmonary valve and outflow tract with bicuspid prosthesis in tetralogy of Fallot

Background. Right ventricular outflow tract and pulmonary valve implant in patients with tetralogy of Fallot may be required to avoid late postoperati ve right ventricular impairment. The use of porcine bicuspid prosthesis mig ht be a technical alternative, although comprehensive studies on the long-t erm use of these prostheses are not available. Methods. Sixty-three patients (aged 5 months to 34 years; mean, 6 years) wi th tetralogy of Fallot and pulmonary hypoplasia underwent surgical repair a nd enlargement of the right ventricular outflow using preserved porcine pul monary bicuspid prostheses. Fifty-two patients (82.5%) were followed and un derwent clinical evaluation and serial Doppler echocardiography. The first 15 patients (29.4%), with ages ranging from 5 to 16 years (mean, 8.2 years) and postoperative follow-up of 48 to 87 months (mean, 65.1 months) underwe nt hemodynamic and cineangiographic evaluations. Results. There were 11 deaths (17.4%) in the early postoperative period. Of the 52 surviving patients (82.5%), 51 (80.9%) were followed for 1 to 87 mo nths (mean, 42.0 months). Four patients (7.6%) had additional treatment. Of the 15 patients (29.1%) undergoing hemodynamic evaluation, 9 (60%), had mi ld valvular pulmonary insufficiency and 6 (40%) had moderate insufficiency. Only the right ventricle-to-pulmonary artery pressure gradients and the ri ght ventricular ejection fraction showed statistically significant differen ces between groups. Right ventricular dimension, although increased in all patients, did not show statistically significant differences. Conclusions. Right ventricular outflow tract and pulmonary valve repair in patients with tetralogy of Fallot using a bicuspid porcine pulmonary prosth esis is a simple, reliable procedure with good results in postoperative med ium term follow-up. (Ann Thorac Surg 2000;70:1911-7) (C) 2000 by The Societ y of Thoracic Surgeons.