Glutaraldehyde treated autologous pericardium in complete repair of tetralogy of Fallot.

Pericardium has been used for decades to facilitate the repair of tetralogy of Fallot (TOF). The impact of glutaraldehyde preserved autologous pericardium when used as a right ventricular outflow tract (RVOFT) patch in TOF was analyzed in 36 consecutive children undergoing complete transventricular repair. In 18 (group I) the pericardium was treated in conventional fashion (harvested and preserved in saline solution). In the other patients, the pericardium was treated in 0.625% glutaraldehyde solution for 20 minutes and then washed in saline prior to being implanted as an RVOFT patch (group II). The perioperative (prior to hospital discharge) as well as the 6-month postoperative Doppler echocardiograms were assessed with 100% follow-up. The studies were evaluated and graded by blinded observers for the presence and severity of an RVOFT dilatation (+0 to +4) relative to the size of the aortic valve annulus. The age of patients in group I and group II (29 months, 34 months) were similar as was the incidence of transannular patching (44%, 41%). Postrepair hemodynamics revealed no significant difference in the right ventricular/left ventricular pressure ratios (42%, 41%) or in the systolic RVOFT pressure (24 mmHg, 29 mmHg). The predischarge echocardiograms showed no outflow tract (OFT) dilation in either group. There was no morbidity or mortality in either group. At approximately 6 months postoperatively (6.2 mo, 5.7 mo), 72% of group I patients had RVOFT diameters that were larger (+1, +2) than the predischarge diameters when reviewed by three observers. In group II there was a single patient with dilatation of the RVOFT and this graded as +1. The mean RVOFT dilation score in group I was 1.06 (+0.8) versus 0.06 (+0.24) in group II (p < 0.05). We conclude that dilute glutaraldehyde preservation of autologous pericardium is a safe and effective means of preventing RVOFT dilatation over the short term in patients in which a hemodynamically acceptable repair of TOF has been completed.