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Ann Thorac Surg 2007;83:726
© 2007 The Society of Thoracic Surgeons

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Correspondence

My View and My Experience on Extracardiac RV-PA Conduit

A.R.N.A.S. Ospedale Civico, Department of Pediatric Cardiac Surgery, Via Carmelo Lazzaro, 2a, Palermo, 90124 Italy

(Email: carlomarcellett{at}tiscali.it).

To the Editor:

I am writing in regard to the recent publication by Schreiber and colleagues [1]. Although their article [1] was well prepared and presented, I am concerned that his conclusions may wrongly convey the notion that xenograft pulmonary valve conduits (PVCs) have no place in the clinical setting. It is my view based on my personal experience with the Shelhigh PVC [2] (Shelhigh Inc, Union, NJ) that it is a valuable tool and one that gains in value daily as homograft availability becomes increasingly limited. I respectfully submit the following points for consideration by your readers and my fellow surgeons:

• Professor Lange’s group in Munich presented its results with 50 Contegra (Medtronic Inc, Minneapolis, MN) implantations about 3 years ago at a meeting in Rostock and reported four cases of sudden death from thrombosis. These results apparently prompted the hospital to discontinue its use of Contegra (Medtronic Inc) and switch to the Shelhigh (Shelhigh Inc) conduit. I also recall reports of difficulty performing reoperations after implantation of the Contegra (Medtronic Inc) due to adhesions. My own experience is that reoperation after implantation of a Shelhigh (Shelhigh Inc) conduit is relatively easy due to the lack of adhesions exhibited by the No-React treated Shelhigh (Shelhigh Inc) conduits.

• Despite the German Heart Center in Munich, having had experience with both Contegra (Medtronic Inc) and the Shelhigh (Shelhigh Inc) conduits, only the results with the Shelhigh (Shelhigh Inc) conduit versus homografts were reported. I agree with Dr Schreiber’s observation that the Shelhigh (Shelhigh Inc) conduit does not calcify and, based on personal experience, also that it does not dilate as has been reported with the Contegra (Medtronic Inc) device. Histologic comparisons of both xenograft products would have provided additional, valuable information to clinicians.

• The 10-mm homografts are often difficult to obtain and can exhibit the same difficulties as xenografts. The availability of an "off-the-shelf" Shelhigh (Shelhigh Inc) conduit often provides surgeons with their only choice and should therefore be a welcome addition to the surgeon’s toolbox in performing right ventricular outflow tract (RVOT) reconstruction.

• It is important to have realistic expectations about the durability of pulmonary conduits. Nothing we know of today will solve the problem of somatic outgrowth in the youngest patients. Homografts, especially in the smaller sizes, often fail early in neonates (within 6 months and sometimes less). I believe that the performance of the Shelhigh (Shelhigh Inc) PVC in the neonate is quite good, and that expecting a conduit to last more than 7 to 9 months is very often just not realistic.

Based on my experience and observations previously mentioned, I maintain that the Shelhigh (Shelhigh Inc) conduit is an excellent alternative to the homograft, and not infrequently the only option available to surgeons for right ventricular outflow tract reconstruction.

	References

Top References

 

1. Schreiber C, Sassen S, Kostolny M, et al. Early graft failure of small-sized porcine-valved conduits in reconstruction of the right ventricular outflow tract Ann Thorac Surg 2006;82:179-185.[Abstract/Free Full Text]
2. Marianeschi SM, Iacona GM, Seddio F, et al. Shelhigh No-React porcine pulmonic valve conduit: a new alternative to the homograft Ann Thorac Surg 2001;71:619-623.[Abstract/Free Full Text]

This article has been cited by other articles:

				J. Horer, A. Eicken, and C. Schreiber Reply Ann. Thorac. Surg., February 1, 2007; 83(2): 726 - 727. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Carlo F. Marcelletti Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Marcelletti, C. F. Search for Related Content PubMed PubMed Citation Articles by Marcelletti, C. F. Related Collections Congenital - cyanotic Related Article