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Collagen sealed Dacron. Implantation for congenital and acquired cardiac defects
L B McGrath1, L Gonzalez-Lavin, J Fernandez
1Department of Surgery, Deborah Heart and Lung Center, Browns Mills, NJ 08015.
Insights
Collagen-sealed Dacron grafts show promising early results for cardiac repair in adults and children. While effective, concerns about intimal peel formation mean pulmonary homografts are still preferred for pediatric valved extracardiac conduits.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
Background:
- Acquired and congenital cardiac defects require surgical repair.
- Dacron prosthetics are utilized in cardiac reconstructions.
Purpose of the Study:
- To evaluate the early outcomes of intracardiac repair using collagen-sealed Dacron grafts.
- To assess the safety and efficacy of this biomaterial in cardiac defect repair.
Main Methods:
- Forty patients with acquired (15) and congenital (25) cardiac defects underwent repair.
- Collagen-sealed Dacron patches, baffles, or tube grafts were employed.
- Exclusion criteria included pediatric patients needing valved extracardiac conduits.
Main Results:
- Actuarial survival was 87% at 37 months, with low rates of bleeding (10%) and no graft leakage.
- No hemolysis was observed; one case of mediastinitis resolved with treatment.
- Actuarial freedom from reoperation was 100% at 37 months.
Conclusions:
- Collagen-impregnated Dacron demonstrates good early clinical results and handling characteristics.
- The material is impermeable, with no instances of graft leakage or hemolysis.
- Pulmonary homografts remain recommended for pediatric valved extracardiac conduits due to intimal peel concerns.
Abstract:
Forty consecutive patients underwent intracardiac repair of acquired (15) and congenital (25) cardiac defects using a collagen sealed Dacron patch, baffle, or tube graft. Mean age at repair was 26.6 years (range, 1-74). Pediatric patients requiring valved extracardiac conduits were excluded from the study. Previous procedures had been done in 14 of the 40 patients (35%). There were three hospital deaths (7.5%), and two late deaths (5.4%), with an actuarial survival of 87 +/- 5.5% at 37 months after repair. Four patients required re-entry for bleeding (10%), but in no patient was bleeding related to leakage through the patch. There were no episodes of hemolysis. Mediastinitis occurred in one patient (2.7%) and resolved with usual treatment. There were no late reoperations, with actuarial freedom from reoperation 100% at 37 months after repair. The authors conclude that surgical implantation of collagen impregnated Dacron provides good early phase results. The collagen treated knitted Dacron has excellent handling characteristics and is impermeable. However, because of concerns regarding the potential for thick intimal peel formation due to variable collagen resorption rates, the authors continue to recommend pulmonary homografts when a valved extracardiac conduit is required in children.