RIGHT VENTRICULAR OUTFLOW TRACT RECONSTRUCTION WITH BIOPULMONIC CONDUIT: A WORD OF CAUTION

Background: The most cost-benefit and affordable conduit to reconstruct right ventricle outflow tract (RVOT) is the pulmonary homograft, which is limited by the procurement and size availability. Xenograft is a good performance alternative, but the dysfunction due to progressive stenosis or regurgitation can be more frequently experienced. Aim of this study is to evaluate the mid-term outcome of Biopulmonic pulmonary conduits. Methods: From 08/2016 to 01/2021, 34 patients underwent RVOT reconstruction with Biopulmonic conduit, a porcine pulmonic bioprosthesis. We collected demographic data and clinical characteristics of patients and, for mid-term follow-up, freedom from conduit failure defined as stenosis or regurgitation resulting in surgical conduit change or percutaneous pulmonary valve implantation. Results: Mean follow-up was 14.65±14.1 months (IQR 3.8-19.8) with a freedom from conduit failure of 58,9% at 19 months. Mean gradient moved from 13.2±8.6 mmHg at 1 month to 26.3±19.6 mmHg at 12 months after surgery (p=0.0367). 11 patients (32.3%) required pulmonary valve replacement, 9 patients were treated with percutaneous valve implantation, 2 patients required surgery of whom one for endocarditis. Corticosteroid therapy in the post-operative period, used to treat pericardial effusion or no infective fever, showed to reduce the conduit dysfunction (p=0.0135). Conclusions: Biopulmonic conduit showed a high failure rate due to a suspected inflammatory reaction. This type of conduit should be used in selected patients and deep control of inflammatory markers is recommended.