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Prosthetic options for neonates and infants with valvular heart disease are limited to traditional fixed diameter mechanical and bioprosthetic valves, which require replacement as the child grows. We test the hypothesis that an adjustable externally stented bovine jugular vein graft can be surgically implanted and expanded subsequently in the catheterization laboratory as the child grows.
Externally stented bovine jugular vein graft (Melody) was modified for surgical implantation into the right ventricular outflow tract (RVOT, n=8), aortic (n=1), and mitral positions (n=6). Valves were only partially expanded at surgical implantation with the intention of sequential expansion in the catheterization laboratory with somatic growth. Patients were prospectively followed to determine short-term valve durability and response to balloon expansion.
Median age at valve implantation was 8 months (range 1.6 mo to 6.6 yrs). Median internal diameter of valve at implantation was 12 mm (range 9 to 18 mm). Valvular regurgitation early postopertively was mild or less in the 13/15 patients, and moderate to severe in 2 patients due to technical reasons (excessive trimming of graft in one patient and perivalvar leak following implantation within PTFE tube graft in another). At median follow up of 1.5 years, 2 patients have undergone re-replacement, both considered to be technical failures. Catheter-based valve expansion has been performed in 7 patients (5 RVOT and 2 mitral) at a median interval of 318 days (range 16 days to 748 days) following implantation. Median balloon size at valve expansion was 12 mm (range 12 to 16 mm). Five of 7 patients with mild or less regurgitation prior to balloon expansion continued to demonstrate mild valvular regurgitation following intervention, whereas the regurgitation remained significant in the 2/7 patients with technical failures.
An adjustable stented bovine jugular vein graft is a novel option for neonates and infants who require surgical valve replacement. At short term follow up, valve durability is acceptable. Valve function remains acceptable following catheter-based expansion up to 1.5 years following implantation.
Oral Contributions North, Room 121
Saturday, March 09, 2013, 9:15 a.m.-9:30 a.m.
Session Title: Congenital Cardiology Solutions: Pediatric
Abstract Category: 14. Congenital Cardiology Solutions: Therapy
Presentation Number: 904-8
- 2013 American College of Cardiology Foundation