Outcomes Of Tricuspid Valve Replacement With A Valve Using Porcine Extracellular Matrix In Children And Young Adults
Frank Scholl, MD, Mark Ruzmetov, MD, PhD, John N. Dentel, MD, Steve Bibevski, MD, PhD.
Joe DiMaggio Children's Hospital, Hollywood, FL, USA.
Objective(s): Tricuspid valve replacement (TVR) in children and young adults is associated with a nonnegligible complication rate because of specific disadvantages of mechanical or biologic prostheses. The objective of this study was to examine the midterm clinical outcomes of TVR with a handmade or created valve using porcine extracellular matrix (ECM) in 8 patients with unrepairable congenital or acquired TV involvement.
Methods: Between 2014 and 2022, TVR with a valve using ECM (handmade, n=4 or created, n=5) was performed in 9 patients (mean age, 28years). Preoperative diagnoses were: Ebstein's anomaly (n=4), TV regurgitation and/or stenosis (n=4), and TV endocarditis (n=1). In all patients with TV valve disease, conservative operations had previously been performed on the TV during concomitant left-sided surgical intervention. One patient (13%) had undergone two previous surgical TVRs with bioprosthetic valve. Median follow-up was 2years (range, 1 month to 9 years) and was complete.
Results: There were one operative and one late death. The mean diameter of implanted valve was 30+4.7mm (range,22-34). None of the patients required ECM-related reoperation. At the most recent echocardiographic examination, 5 patients had trivial residual tricuspid regurgitation, and 3 had mild tricuspid regurgitation. The mean peak tricuspid gradient was 9+7mmHg (range,4-24).
Conclusions: On the basis of our midterm results, TVR with a valve using porcine ECM seems to be a valuable alternative surgical option for children and young adult patients with TV disease. A custom TV using decellularized porcine ECM is innovative, safe, and feasible without technical issues and demonstrates acceptable mid-term function.
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