Pulmonary Allograft Versus Medtronic Freestyle Valve in Surgical Pulmonary Valve Replacement for Adults Following Correction of Tetralogy of Fallot or Its Variants

Author:

Wijayarathne Pasangi Madhuka1,Skillington Peter234,Menahem Samuel56,Thuraisingam Amalan2,Larobina Marco234,Grigg Leeanne7

Affiliation:

1. Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia

2. Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia

3. Department of Cardiothoracic Surgery, Melbourne Private Hospital, Parkville, Victoria, Australia

4. Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia

5. Department of Cardiology, Epworth and Melbourne Private Hospital, Melbourne, Victoria, Australia

6. School of Clinical Sciences, Monash Health, Monash University, Clayton, Victoria, Australia

7. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia

Abstract

Background: Following corrective surgery in infancy/childhood for tetralogy of Fallot (TOF) or its variants, patients may eventually require pulmonary valve replacement (PVR). Debate remains over which valve is best. We compared outcomes of the Medtronic Freestyle valve with that of the pulmonary allograft valve following PVR. Methods: A retrospective study was undertaken from a single surgical practice of adult patients undergoing elective PVR between April 1993 and March 2017. The choice of valve was at the surgeon’s discretion. There was a trend toward the almost exclusive use of the more readily available Medtronic Freestyle valve since 2008. Results: One hundred fifty consecutive patients undergoing 152 elective PVRs were reviewed. Their mean age was 33.8 years. Ninety-four patients had a Medtronic Freestyle valve, while 58 had a pulmonary allograft valve. There were no operative or 30-day mortality. The freedom from reintervention at 5 and 10 years was 98% and 98% for the pulmonary allograft and 99% and 89% for the Medtronic Freestyle. There was no significant difference in the rate of reintervention, though this was colored by higher pulmonary gradients across the Medtronic Freestyle despite its shorter follow-up. Conclusions: Pulmonary valve replacement following previous surgical repair of TOF or its variants was found to be safe with no significant differences in mortality or reintervention between either valve. Although the Medtronic Freestyle valve had a greater tendency toward pulmonary stenosis, additional follow-up is needed to further document its long-term outcomes.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,General Medicine,Pediatrics, Perinatology and Child Health,Surgery

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