Objective: The optimal conduit for reconstruction of the right ventricular outflow tract (RVOT) in patients with congenital heart disease remains controversial. The Freestyle stentless aortic root bioprosthesis, which offers potential advantages including accessibility, extensive size range and anti-calcification treatment, has been used increasingly for this indication however the outcome for this strategy of RVOT reconstruction remains to be defined.

Methods: Outcomes for patients undergoing RVOT reconstruction using Freestyle stentless aortic root bioprostheses in Perth, Australia from December 2000 to September 2008 were retrospectively reviewed. Clinical data was acquired prospectively and all patients underwent routine post-operative follow-up by a cardiologist and cardiothoracic surgeon.

Results: 61 patients (mean age 23.6 ± 2.3 yr; 59% male) underwent 65 pulmonary valve replacements using Freestyle aortic root bioprotheses (mean size 24.2 ± 0.5 mm) for heterogenous indications (pulmonary regurgitation (n=29), RV-PA conduit stenosis (n=23), pulmonary stenosis (n=6), pulmonary atresia (n=5), truncus arteriosus (n=1) and other (n=1)). Operative mortality was 0% however overall mortality was 4.9 % (n=3) during follow-up. No episodes of thromboembolism occurred and redo surgery was required in 4 patients (endocarditis (n=2), conduit stenosis (n=2)). Peak pulmonary valve gradient during short to medium term follow-up was 23.8 ± 1.9 mmHg.

Conclusion: The Freestyle stentless aortic root bioprosthesis is an effective conduit for reconstructing the RVOT in a heterogenous patient cohort with diverse native or prosthetic pulmonary valve pathology. Longer follow-up is required to accurately determine the lifespan of this bioprosthesis in the pulmonary position, particularly in relation to valve and patient size.