@Article{chd.12765,
AUTHOR = {James A. Kuo, Tyler Hamby, Maham N. Munawar, Eldad Erez, Vincent K. H. Tam},
TITLE = {Midterm outcomes of right ventricular outflow tract reconstruction using the Freestyle xenograft},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {4},
PAGES = {651--656},
URL = {http://www.techscience.com/schd/v14n4/39284},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> 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.<br/>
<b>Design:</b> 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.<br/>
<b>Results:</b> 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 m<sup>2</sup> (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.<br/>
<b>Conclusions:</b> 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.},
DOI = {10.1111/chd.12765}
}