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Early and late results of fresh autologous pericardial valved conduits
Christian Kreutzer1, Guillermo O. Kreutzer, Rita De C Mayorquim
1Division of Cardiovascular Surgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina.
Insights
Autologous pericardial valved conduits show good early and excellent long-term results for pulmonary circulation. This study found favorable outcomes and durability compared to other conduit options.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Venous ventricle-pulmonary artery continuity is crucial in complex congenital heart disease.
- Autologous pericardium offers a readily available and potentially cost-effective biomaterial for valve conduit construction.
Purpose of the Study:
- To assess the early and late clinical outcomes of autologous pericardial valved conduits.
- To evaluate the functional performance and durability of these conduits in the pulmonary circulation.
Main Methods:
- Retrospective analysis of 86 patients (15 days to 24 years) who received autologous pericardial valved conduits between 1983 and 1997.
- Regular Doppler echocardiography for monitoring valve function, pulmonary regurgitation, and stenosis.
- Long-term follow-up of survivors to assess reintervention rates and overall survival.
Main Results:
- Early mortality was 15% (13 deaths).
- Pulmonary regurgitation was common, with mild to moderate levels in most patients postoperatively.
- The mean conduit diameter increased significantly over time (15.8 mm to 18.21 mm, P <.0001).
- Freedom from reintervention at 5 and 10 years was 89% and 80%, respectively, with only one conduit replacement needed.
Conclusions:
- Autologous pericardial valved conduits demonstrate favorable early and excellent long-term results in the pulmonary circulation.
- Their performance and durability are comparable to other available conduit options.
- This technique represents a viable surgical strategy for achieving venous ventricle-pulmonary artery continuity.
Abstract:
The objective of this study was to evaluate the early and late results of an autologous pericardial valved conduit in the pulmonary circulation. Between 1983 and 1997, 86 autologous pericardial valved conduits were used to achieve venous ventricle-pulmonary artery continuity. The mean patient age at the time of implantation was 4.16 +/- 4.10 years (15 days to 24 years). All patients had two-dimensional postoperative and yearly Doppler echocardiograms in which the valve function and the presence of distal, valvar, and proximal stenosis were evaluated. There were 13 early deaths (15%). Twenty-one patients (24.4%) showed trivial, 54 (62.8%) mild, nine (10.4%) moderate, and two (2.3%) severe pulmonary regurgitation in the early postoperative period. The 73 survivors were monitored from 1 to 15 years (mean, 6.5 years; median, 7.1 years). There were five late deaths. The mean conduit diameter at the time of implantation was 15.8 mm, increasing to 18.21 mm at last evaluation (P <.0001). There were nine reoperations, with only one conduit replacement. Freedom from reintervention at 5 and 10 years was 89% and 80%, respectively. In conclusion, autologous pericardial valved conduits provide good early and excellent long-term results that compare favorably with those of other conduits. Copyright 1999 by W.B. Saunders Company
