Early results of right ventricular-pulmonary artery conduits in patients under 1 year of age
| Autor: | John G.C. Wright, E. D. Silove, William J. Brawn, Paul Miller, J V De Giovanni, A.J. Levine, B. Sethia, O.S. Stumper |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Pulmonary and Respiratory Medicine
Heart Defects Congenital medicine.medical_specialty Heart disease Heart Ventricles Transplantation Heterologous Autopsy Anastomosis Pulmonary Artery medicine.artery medicine Ventricular outflow tract Humans Transplantation Homologous Heart valve Derivation Retrospective Studies business.industry Infant Newborn Infant General Medicine medicine.disease Surgery Blood Vessel Prosthesis Stenosis surgical procedures operative medicine.anatomical_structure Pulmonary artery cardiovascular system Cardiology and Cardiovascular Medicine business |
| Zdroj: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 19(2) |
| ISSN: | 1010-7940 |
| Popis: | Objectives: Management strategies for the repair of many complex heart defects require the implantation of a valved conduit between the right ventricle (RV) and the pulmonary artery (PA), often using aortic or pulmonary homograft valves. Their limited availability, however, has led to the development and use of new conduits. We retrospectively compared our experience with small homografts in patients of less than 1 year of age with the TissueMede bioprosthetic valved conduit. Methods: From March 1994 to November 1997 29 patients in their first year of life underwent conduit implantation for complex heart defects. These were retrospectively reviewed in order to determine the incidence of death or conduit stenosis. Seventeen patients received homografts and 12 TissueMede conduits. Results: Diagnoses and operative details including conduit size were similar in the two groups and in all cases complete repair of the underlying defect was carried out. Early post-operative mortality was 4/17 (23.5%) in the homograft group and 3/12 (25%) in the TissueMede group. Echo Doppler evaluation within 1 month of operation showed no right ventricular outflow tract (RVOT) obstruction in any of the survivors. In the TissueMede group 8/9 (77%) survivors have gone on to develop significant RVOT obstruction within 12 months of operation. There have been three late deaths in this group all related to severe RVOT obstruction. Two patients died during an attempt at balloon dilatation and one patient died of progressive right heart failure. Five patients had successful replacement of the TissueMede conduit. One child remains well with no evidence of RVOT obstruction. At operation to replace conduit, or at autopsy, the stenoses were related to the deposition of fibrous tissue at the anastomotic suture lines. In the homograft group none of the survivors developed RVOT obstruction during the first 12 months post-operatively. There was one late death (non-cardiac in origin) and one child is awaiting conduit replacement 40 months after initial implantation for obstruction. Conclusions: The homograft is a satisfactory conduit for re-establishment of RV‐PA continuity in infancy. Further work needs to be undertaken in order to elucidate the mechanisms of early graft failure in bioprosthetic conduits if these are to be a suitable alternative for RV outflow reconstruction in infants. q 2001 Elsevier Science B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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