Medium-term outcomes after pulmonary valve replacement with the Freestyle valve for congenital heart disease: a case series

Abstract

Objectives: The Freestyle valve may be used for pulmonary valve replacement (PVR). Whether its stentless design and anticalcification treatment improve durability relative to alternative bioprostheses, however, is unknown and long-term data are lacking.

Methods: We performed a retrospective review of all Freestyle PVRs performed by a single surgeon in two institutions. All patients were contacted for follow-up to establish survival, New York Heart Association class and reintervention. Up to date, echocardiography was obtained to assess valve function. Perioperative factors associated with structural valve dysfunction (SVD) were assessed using Cox regression.

Results: Between 2000 and 2014, PVR with a Freestyle valve was performed in 114 patients with congenital heart disease. There were 70 males and 44 females. The median age was 21 years (interquartile range 11-35 years). The median clinical and echocardiographic follow-up was 62 months (interquartile range 35-115 months, n = 110) and 58 months (interquartile range 30-93 months, n = 107), respectively. Follow-up was complete for 107 of 114 patients (94%). The survival rate was 95% at 5 years and 91% at 10 years. The rate of freedom from SVD at 5 years was 82%, and at 10 years was 61%. The reintervention-free survival rate was 85% at 5 years, and 71% at 10 years.

Conclusion: The Freestyle valve in the pulmonary position in a congenital population is associated with low medium-term incidences of SVD and reintervention. It performs equally well to the homograft when a conduit is required and can be considered a valid alternative to stented bioprostheses when PVR alone is required.

Keywords: CHD; Pulmonary valve; Right ventricle; Tetralogy of Fallot; Valve.