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Midterm outcomes of right ventricular outflow tract reconstruction using the Freestyle xenograft

James A. Kuo1, Tyler Hamby2, Maham N. Munawar3, Eldad Erez4, Vincent K. H. Tam5
1 Department of Cardiology, Cook Children’s Medical Center, Fort Worth, Texas
2 Department of Research, Cook Children’s Healthcare System, Fort Worth, Texas
3 School of Medicine, University of North Texas Health Sciences Center, Fort Worth, Texas
4 Department of Cardiothoracic Surgery, Hadassah Medical Center, Jerusalem, Israel
5 Department of Cardiothoracic Surgery, Cook Children’s Medical Center, Fort Worth, Texas
* Corresponding Author: James A. Kuo, MD, Department of Cardiology, Cook Children’s Medical Center, 1500 Cooper Street, 3rd Floor, Fort Worth, TX 76104. Email:

Congenital Heart Disease 2019, 14(4), 651-656.


Objective: Various options exist for right ventricular outflow tract (RVOT) recon‐ struction in congenital heart disease. The Freestyle porcine aortic root may be used but its longevity is not well defined.
Design: We performed a retrospective review of all non‐Ross RVOT reconstructions using the Freestyle root in our institution. Survival and reintervention, either by sur‐ gery, transcatheter valve implantation, balloon valvuloplasty, or bare metal stent placement, were recorded. Factors associated with reintervention were assessed using Cox regression.
Results: Between January 2002 and December 2015, there were 182 patients identi‐ fied. Sixteen patients were lost to follow‐up and 3 patients died, unrelated to cardiac surgery. Of the remaining 163 patients, the median age was 12.2 years (interquartile range 6.4‐16.4), median weight was 39.0 kg (interquartile range 19.9‐59.3), and the median body surface area was 1.23 m2 (interquartile range 0.79‐1.64). Ninety‐three (57%) patients had tetralogy of Fallot. The median follow‐up was 5.4 years (inter‐ quartile range 2.9‐8 years). There were no operative or cardiac‐related deaths. Thirty‐eight patients (23%) required reintervention. The rate of freedom from rein‐ tervention was 93.2% (95% CI 86.7%‐96.6%) at 5 years and 48.4% (95% CI 34.9%‐60.6%) at 10 years. Age < 10 years, weight < 39 kg, and body surface area <1.2 m2 at the time of valve placement, as well as valve size ≤25 mm were signifi‐ cantly associated with need for earlier reintervention.
Conclusions: The Freestyle root in the RVOT is associated with excellent survival and low midterm need for reintervention. Its longevity is comparable to published data on homografts and other bioprosthetic valves.


bioprosthetic valve, right ventricular outflow tract reconstruction

Cite This Article

Kuo, J. A., Hamby, T., Munawar, M. N., Erez, E., K., V. (2019). Midterm outcomes of right ventricular outflow tract reconstruction using the Freestyle xenograft. Congenital Heart Disease, 14(4), 651–656.

This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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