Options for right ventricular outflow tract reconstruction

The popularity of the Ross operation has drawn attention to the need for a satisfactory replacement of the excised pulmonary valve and artery. Although living autogenous tissue is desirable, it has not been possible to manufacture a satisfactory living conduit, and pulmonary homografts have provided a satisfactory long-term solution. Now, with the increasing shortage of homografts, a number of alternative options have to be considered. The most useful and readily acceptable replacement is a porcine pulmonary xenograft, which is now commercially available. Other prospects for future consideration relate to the use of transgenic pig tissue and developing techniques of tissue engineering. In emergency conditions where a valve conduit is unavailable, a temporary solution is to use a simple tube of autogenous pericardium.