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Ann Thorac Surg 1999;68:542-548
© 1999 The Society of Thoracic Surgeons

Original Articles

Valved homograft conduit repair of the right heart in early infancy

Jean Perron, MDa,b, Adrian M. Moran, MDa,b, Kimberlee Gauvreau, ScDa,b, Pedro J. del Nido, MDa,b, John E. Mayer, Jr, MDa,b, Richard A. Jonas, MDc,d

a Departments of Department of Cardiology, Children’s Hospital, Boston, Massachusetts, USA
b Department of Cardiac Surgery, Children’s Hospital, Boston, Massachusetts, USA
c Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
d Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA

Address reprint requests to Dr Jonas, Department of Cardiac Surgery, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115

Background. Valved homograft conduit repair in neonates and young infants creates a physiologically normal biventricular circulation, and unlike shunts, avoids surgery on the branch pulmonary.

Methods. Retrospective chart review was used for 84 patients operated on between 1990 and 1995 (mean age 26 ± 28 days, mean weight 3.3 ± 0.8 kg) undergoing homograft conduit repair in the first 3 months of life. Cases were divided into simple and complex, eg, absent pulmonary valve syndrome or associated interrupted arch. Mean homograft size was 9.0 ± 2 mm.

Results. Early mortality was 4.7% (simple) and 30% (complex). Mean hospital stay was 18 days. Mean follow-up was 34 months. Thirty-seven (47%) patients underwent conduit replacement. Median time to reoperation was 3.1 years. Mean size of replacement homograft was 17 ± 2 mm. There were no deaths at reoperation. Mean hospital stay at conduit change was 6.3 days. Probability of survival at 5 years is 75%.

Conclusions. Biventricular repair employing a conduit can be performed safely in noncomplex anomalies in the first 3 months of life. Time interval until repeat surgery is relatively short but equal or greater than that with most palliative procedures.




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