Performance of bicuspidized pulmonary allografts compared with standard trileaflet allografts

Background: Pulmonary allografts are commonly used in the reconstruction of the right ventricular outflow tract. However, in pediatric patients, allografts that are small enough are often unavailable. To downsize larger, more readily available conduits, one leaflet can be excised, forming a bicuspid valve. The aim of this study was to assess the intermediate-term durability of bicuspidized allografts compared with standard allografts. Methods: Forty-seven patients who received a bicuspidized allograft from 1998 to 2008 were compared with 51 patients who received a standard allograft during the same time period. Outcome measures included need for and timing of reintervention, degree of pulmonary stenosis, insufficiency at most recent follow-up, and survival. Results: On average, the bicuspidized allograft patients were younger, weighed less, and received smaller valves more frequently placed in a heterotopic position than the standard allograft patients. The mean peak gradient across the conduit and the degree of pulmonary insufficiency at discharge were similar between the comparison groups. No statistical differences in need for or timing of reintervention were observed between the surgical groups. Conclusions: Bicuspidized allografts performed similarly to that of standard allografts with regard to the need for reintervention, the development of stenosis or regurgitation, and patient survival. Based on this patient sample, the bicuspidized allograft technique appears to provide an excellent option to expand the availability of small-sized allografts for the reconstruction of the right ventricular outflow tract.