|
|
||||||||
Ann Thorac Surg 1991;52:285-290
© 1991 The Society of Thoracic Surgeons
Victorian Paediatric Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, Australia
Accepted for publication May 16, 1991.
* Address reprint requests to Mr Mee, Victorian Paediatric Cardiac Surgical Unit, Royal Children's Hospital, Flemington Rd, Parkville, 3052, Victoria, Australia.
Extracardiac valved conduits represent one of the weakest facets of reconstructive surgery for congenital heart disease in that they invariably need to be replaced because of growth of the patient or because of valve or conduit failure. Between 1979 and 1989, 141 patients had 169 valved conduits placed between the heart and the pulmonary artery circuit. There were 81 male and 60 female patients, aged 2 days to 35 years (mean age, 5.9 years), with 46 patients less than 1 year of age. We performed primary repair in 117 patients; in this group, there have been 28 conduit replacements in 27 patients. In 17 patients initial repair with a conduit was performed elsewhere and we replaced these conduits in 15 and removed them in 2. A further group of 9 patients were seen after repair of tetralogy of Fallot or double-outlet right ventricle, with severe pulmonary incompetence or right ventricular outflow tract aneurysm. All had valved conduits inserted as secondary procedures. The types of valved conduits used were xenograft (n = 126) and homograft (n = 43). There were six hospital deaths (3.6%; 70% confidence limits [CL], 2% to 6%) and seven late deaths (4.1%; CL, 2.5% to 6.5%) in a total of 169 conduit insertions. Forty-five conduits have been removed and 43 reinserted without early or late mortality (0%; CL, 0% to 4%). Actuarial survival after conduit insertion was 87% at 5 years (CL, 80% to 92%), including operative mortality. Actuarial freedom from conduit replacement was 37% at 5 years (CL, 20% to 56%). Conduit insertion in infants and small children ensures subsequent replacement, but this can be done at low risk. Our policy therefore has been to attempt to match the conduit to the size of the patient rather than to insert a large conduit. Our current approach is to use a Dacron conduit at initial repair to establish a prosthetic sewing margin adjacent to the left main and left anterior descending coronary arteries for safe subsequent replacement, preferably with a cryopreserved homograft. Replacement should be done before development of important right ventricular dysfunction.
This article has been cited by other articles:
![]() |
L. Sasson, S. Houri, A. Raucher Sternfeld, I. Cohen, O. Lenczner, E. L. Bove, L. Kapusta, and A. Tamir Right ventricular outflow tract strategies for repair of tetralogy of Fallot: effect of monocusp valve reconstruction Eur J Cardiothorac Surg, April 1, 2013; 43(4): 743 - 751. [Abstract] [Full Text] [PDF] |
||||
![]() |
I.-S. Chiu, M. Div, S.-C. Huang, S.-J. Wu, M.-L. Lee, E.-T. Wu, S.-J. Chen, and M.-R. Chen Surgical Treatment of Anomalies With Discontinuity Between the Right Ventricle and the Pulmonary Arteries Without Use of an Extracardiac Conduit Ann. Thorac. Surg., April 1, 2009; 87(4): 1220 - 1226. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. Troost, B. Meyns, W. Daenen, F. Van de Werf, M. Gewillig, K. Van Deyk, P. Moons, and W. Budts Homograft survival after tetralogy of Fallot repair: determinants of accelerated homograft degeneration Eur. Heart J., October 2, 2007; 28(20): 2503 - 2509. [Abstract] [Full Text] [PDF] |
||||
![]() |
P. Anagnostopoulos, A. Azakie, S. Natarajan, N. Alphonso, M. M. Brook, and T. R. Karl Pulmonary valve cusp augmentation with autologous pericardium may improve early outcome for tetralogy of Fallot J. Thorac. Cardiovasc. Surg., March 1, 2007; 133(3): 640 - 647. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Koh, T. Yagihara, H. Uemura, K. Kagisaki, I. Hagino, T. Ishizaka, and S. Kitamura Long-term outcome of right ventricular outflow tract reconstruction using a handmade tri-leaflet conduit Eur J Cardiothorac Surg, May 1, 2005; 27(5): 807 - 814. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Koh, T. Yagihara, H. Uemura, K. Kagisaki, and S. Kitamura Functional biventricular repair using left ventricle-pulmonary artery conduit in patients with discordant atrioventricular connections and pulmonary outflow tract obstruction--does conduit obstruction maintain tricuspid valve function? Eur J Cardiothorac Surg, October 1, 2004; 26(4): 767 - 772. [Abstract] [Full Text] [PDF] |
||||
![]() |
Y. Isomatsu, T. Shin'oka, M. Aoki, M. Terada, T. Takeuchi, S. Hoshino, Y. Takanashi, Y. Imai, and H. Kurosawa Establishing right ventricle-pulmonary artery continuity by autologous tissue: an alternative approach for prosthetic conduit repair Ann. Thorac. Surg., July 1, 2004; 78(1): 173 - 180. [Abstract] [Full Text] [PDF] |
||||
![]() |
K. R. Kanter, D. A. Fyfe, W. T. Mahle, J. M. Forbess, and P. M. Kirshbom Results with the freestyle porcine aortic root for right ventricular outflow tract reconstruction in children Ann. Thorac. Surg., December 1, 2003; 76(6): 1889 - 1895. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. Ishizaka, R. G. Ohye, C. S. Goldberg, S. R. Ramsburg, T. Suzuki, E. J. Devaney, and E. L. Bove Premature failure of small-sized Shelhigh No-React porcine pulmonic valve conduit model NR-4000 Eur J Cardiothorac Surg, May 1, 2003; 23(5): 715 - 718. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. Erek, Y. K. Yalcinbas, E. Salihoglu, N. Ozturk, S. Arat, A. Sarioglu, U. B. Samanli, and T. Sarioglu Fate of Stentless Bioprostheses on Right Side of the Heart Asian Cardiovascular and Thoracic Annals, March 1, 2003; 11(1): 58 - 62. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. A. Dearani, G. K. Danielson, F. J. Puga, H. V. Schaff, C. W. Warnes, D. J. Driscoll, C. D. Schleck, and D. M. Ilstrup Late follow-up of 1095 patients undergoing operation for complex congenital heart disease utilizing pulmonary ventricle to pulmonary artery conduits Ann. Thorac. Surg., February 1, 2003; 75(2): 399 - 411. [Abstract] [Full Text] [PDF] |
||||
![]() |
W. J. Wells, H. Arroyo Jr, R. M. Bremner, J. Wood, and V. A. Starnes Homograft conduit failure in infants is not due to somatic outgrowth J. Thorac. Cardiovasc. Surg., July 1, 2002; 124(1): 88 - 96. [Abstract] [Full Text] [PDF] |
||||
![]() |
Y. J. Kim, Y. S. Choi, J. R. Lee, and J. R. Rho Ventricular Outflow Tract Reconstruction with Polystan Valved Conduit Asian Cardiovascular and Thoracic Annals, September 1, 2001; 9(3): 187 - 191. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. Lange, J. Weipert, M. Homann, N. Mendler, S.-U. Paek, K. Holper, and H. Meisner Performance of allografts and xenografts for right ventricular outflow tract reconstruction Ann. Thorac. Surg., May 1, 2001; 71(2007): S365 - S367. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. M. Marianeschi, G. M. Iacona, F. Seddio, R. F. Abella, C. Condoluci, A. Cipriani, F. S. Iorio, S. Gabbay, and C. F. Marcelletti Shelhigh No-React porcine pulmonic valve conduit: a new alternative to the homograft Ann. Thorac. Surg., February 1, 2001; 71(2): 619 - 623. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. A. Caldarone, B. W. McCrindle, G. S. Van Arsdell, J. G. Coles, G. Webb, R. M. Freedom, and W. G. Williams Independent factors associated with longevity of prosthetic pulmonary valves and valved conduits J. Thorac. Cardiovasc. Surg., December 1, 2000; 120(6): 1022 - 1031. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. O. Fulton, C. Mas, C. P.R. Brizard, A. D. Cochrane, and T. R. Karl Does left ventricular outflow tract obstruction influence outcome of interrupted aortic arch repair? Ann. Thorac. Surg., January 1, 1999; 67(1): 177 - 181. [Abstract] [Full Text] [PDF] |
||||
![]() |
K. Niwaya, C. J. Knott-Craig, M. M. Lane, K. Chandrasekaren, E. D. Overholt, and R. C. Elkins CRYOPRESERVED HOMOGRAFT VALVES IN THE PULMONARY POSITION: RISK ANALYSIS FOR INTERMEDIATE-TERM FAILURE J. Thorac. Cardiovasc. Surg., January 1, 1999; 117(1): 141 - 147. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. Robin, S. Martinot, A. Curtil, C. Vedrinne, F. Tronc, M. Franck, and G. Champsaur Experimental right ventricle to pulmonary artery discontinuity: Outcome of polyurethane valved conduits J. Thorac. Cardiovasc. Surg., April 1, 1998; 115(4): 898 - 903. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. Stark, C. Bull, M. Stajevic, M. Jothi, M. Elliott, and M. d. Leval Fate Of Subpulmonary Homograft Conduits: Determinants Of Latehomograft Failure J. Thorac. Cardiovasc. Surg., March 1, 1998; 115(3): 506 - 516. [Abstract] [Full Text] |
||||
![]() |
M. Ando, Y. Imai, Y. Takanashi, S. Hoshino, K. Seo, and M. Terada Fate of Trileaflet Equine Pericardial Extracardiac Conduit Used for the Correction of Anomalies Having Pulmonic Ventricle-Pulmonary Arterial Discontinuity Ann. Thorac. Surg., July 1, 1997; 64(1): 154 - 158. [Abstract] [Full Text] |
||||
![]() |
K. J. Prasanna, R. Sharma, K. S. Iyer, B. Airan, A. Bhan, S. S. Kothari, A. Saxena, I. M. Rao, and P. Venugopal Single versus Biventricular Repair for Discordant Hearts Asian Cardiovascular and Thoracic Annals, September 1, 1996; 4(3): 161 - 163. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. Mishaly, E. Birk, A. Elami, and B. A. Vidne Autologous Monocusp Pulmonary Valve: Preliminary Results Ann. Thorac. Surg., June 1, 1996; 61(6): 1811 - 1815. [Abstract] [Full Text] |
||||
![]() |
J. Weipert, H. Meisner, N. Mendier, J. C. Haehnel, M. Homann, S.-U. Paek, and F. Sebening Allograft implantation in pediatric cardiac surgery: Surgical experience from 1982 to 1994 Ann. Thorac. Surg., August 1, 1995; 60(suppl_2): S101 - S104. [Abstract] [PDF] |
||||
![]() |
M. N. Kumar, G. Prabakar, N. Kumar, M. Shahid, A. E. Becker, and C. M. G. Duran Autologous glutaraldehyde-treated pericardial valved conduit: An experimental study Ann. Thorac. Surg., August 1, 1995; 60(suppl_2): S200 - S204. [Abstract] [PDF] |
||||
![]() |
M. Ando, Y. Imai, S. Hoshino, and K. Ishihara Autologous reconstruction of pulmonary trunk at reoperation after extracardiac conduit repair Ann. Thorac. Surg., March 1, 1995; 59(3): 621 - 625. [Abstract] [PDF] |
||||
![]() |
K. Bando, G. K. Danielson, H. V. Schaff, D. D. Mair, P. R. Julsrud, and F. J. Puga Outcome of pulmonary and aortic homografts for right ventricular outflow tract reconstruction J. Thorac. Cardiovasc. Surg., March 1, 1995; 109(3): 509 - 518. [Abstract] [Full Text] |
||||
![]() |
Y. J. Kim, H. Song, J. R. Lee, J. R. Rho, and K. P. Suh Lecompte procedure for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis Ann. Thorac. Surg., April 1, 1994; 57(4): 876 - 879. [Abstract] [PDF] |
||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |