Perimount bovine pericardial valve to restore pulmonary valve competence late after right ventricular outflow tract repair

Congenit Heart Dis. Mar-Apr 2007;2(2):115-20. doi: 10.1111/j.1747-0803.2007.00083.x.

Abstract

Objective: No ideal option exists for restoring pulmonary valve competence late after repair of the congenitally abnormal right ventricular outflow tract (RVOT). This has driven a continued search for new alternatives. Texas Children's Hospital has recently used the Carpentier-Edwards Perimount RSR Pericardial Aortic Prosthesis (Edwards Lifesciences, Irvine, Calif, USA) for this indication and reports the initial experience.

Design: Retrospective chart review.

Setting: Academically affiliated tertiary-care pediatric hospital.

Patients: Twenty-six patients who underwent pulmonary valve replacement with the Perimount valve late after RVOT reconstruction between June 2002 and November 2005.

Interventions: No prospective interventions.

Outcomes measures: Hospital morbidity and mortality. Valve function assessed by follow-up visits and echocardiograms.

Results: Mean age and weight of the patients were 20.3 +/- 9.8 years (range 7.0-45.1 years) and 56.2 +/- 18.1 kg (range 35.8-109 kg). Twenty-two patients (85%) had severe pulmonary insufficiency (PI), 23 (89%) had symptomatic right heart failure, and 14 (54%) had moderate to severe right ventricular dysfunction. Average prosthetic valve size was 23 mm (range 19-27 mm). Twenty-one (88%) patients were extubated within 24 hours. There was no hospital mortality. Median length of stay for all patients from day of surgery was 6 days (range 3-56 days). Median length of last echocardiography follow-up was 12.4 months (range 0.1-37.6 months). At that time, 16 of the 26 (62%) patients had improved right ventricular function, no patient demonstrated significant RVOT obstruction, and 24 patients (92%) have no PI or mild PI. Freedom from death, reintervention, or reoperation on the pulmonary valve is 100% at 2.5 years.

Conclusion: Initial results with the Perimount bovine pericardial tissue prosthesis for pulmonary valve replacement are encouraging. Further follow-up is required to define long-term function and durability.

MeSH terms

  • Animals
  • Aortic Valve
  • Bioprosthesis*
  • Cattle
  • Cohort Studies
  • Heart Valve Prosthesis Implantation*
  • Heart Valve Prosthesis*
  • Humans
  • Length of Stay
  • Pericardium*
  • Pulmonary Valve / physiopathology
  • Pulmonary Valve / surgery*
  • Retrospective Studies
  • Treatment Outcome
  • Ventricular Outflow Obstruction / physiopathology*
  • Ventricular Outflow Obstruction / surgery*