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Tailored Bicuspid Pulmonary Valve In Tetralogy Repair With Non-preservable Valve
Osman O. Al-Radi, FRCSC.
University of California Los Angeles, Los Angeles, CA, USA.
Objective(s): The pulmonary valve is not preservable in a significant proportion of Tetralogy of Fallot (TOF) patients due severe valve dysplasia or annular hypoplasia. In such patients a transannular patch is necessary. Without a competent valve the right ventricle in such patients is subjected to the ill-effects of wide-open pulmonary regurgitation with postoperative and long-term deleterious consequences. The presented technique is an expansion on the monocusp valve repair largely abandoned due to poor outcomes.
Methods: A tailored bicuspid pulmonary valve is created using decellularized equine pericardium (Autotissue ®, Germany). This material has the required pliability to create tailored leaflets and an outflow patch with a reliable and potentially durable outcome. The accompanying video demonstrates the surgical technique and the intraoperative competence of the tailored valve.
Results: Over a 3-year period, 52 patients underwent TOF repair with a tailored valve. One patient required balloon dilation 4 months after surgery with resolution of a significant gradient. None of the patients required reoperation. At 6 months follow-up normal RV function was found in 88% of the tailored valve patients compared to 36% of patients who underwent TOF repair with transannular patch without a valve.
Conclusions: A tailored pulmonary valve with equine pericardium in TOF repair with transannular patch reliably restores pulmonary competence and may improve short and long term outcomes.
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