Related Experiment Videos
Long-term results after extracardiac valved conduits implanted for complex congenital heart disease
A Corno1, A Giamberti, S Giannico
1Department of Medicine, Hospital of Baby Jesus, Rome, Italy.
Insights
Extracardiac valved conduits were implanted in 56 pediatric patients for complex congenital heart disease. The collagen-sealed Tascon conduit showed a higher reoperation rate compared to the conventional Dacron conduit.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Complex congenital heart disease often requires surgical intervention with extracardiac valved conduits.
- Evaluating the long-term performance and complications of different conduit types is crucial for patient outcomes.
Purpose of the Study:
- To assess the outcomes of extracardiac valved conduits in pediatric patients with complex congenital heart disease.
- To compare the reoperation rates between conventional Dacron conduits and collagen-sealed Tascon conduits.
Main Methods:
- Retrospective analysis of 56 patients who underwent extracardiac valved conduit implantation between 1982 and 1986.
- Review of patient diagnoses, conduit types (conventional Dacron conduit vs. Tascon conduit), and follow-up data.
- Utilized echocardiography, cardiac catheterization, and assessment of reoperation rates and interventions like balloon dilatation.
Main Results:
- Two conduit-unrelated deaths occurred in 56 patients (3.6%) during a mean follow-up of 32.5 months.
- The Tascon conduit group had a significantly higher incidence of conduit replacement (36.8%) compared to the conventional Dacron conduit group (5.5%).
- Percutaneous transluminal balloon dilatation provided adequate gradient relief in four out of five patients.
Conclusions:
- Extracardiac valved conduits can be safely implanted for complex congenital heart disease with low mortality.
- The collagen-sealed Tascon conduit demonstrated a higher rate of reoperation compared to the conventional Dacron conduit.
- Further research is needed to optimize conduit selection and management strategies.
Abstract:
Between August 1982 and December 1986, 56 patients survived implantation of an extracardiac valved conduit for complex congenital heart disease. The mean age at operation was 4.2 years (16 days to 24 yrs) and the mean weight was 15.9 kg (2.4 to 93.0 kg). The diagnosis was pulmonary atresia (PA) with ventricular septal defect (VSD) in 13 patients, tetralogy of Fallot in 11, transposition of the great arteries (TGA) with VSD in 8, truncus arteriosus, in 7, complex left ventricular outflow tract obstruction (LVOTO) in 6, complex left atrioventricular valve obstruction in 4, double outlet right ventricle with VSD and subaortic obstruction in 3, univentricular heart with pulmonary stenosis in 2, TGA with LVOTO in 1, and PA with intact ventricular septum in 1. In 35 patients, a preclotted conventional Dacron conduit (CDC) with bioprosthetic valve was used, in 19 patients a collagen-sealed Tascon valved conduit (TC) was implanted, and in 1 patient an aortic homograft was used. In a mean follow-up of 32.5 months (9 to 64 mo), there were two deaths (2/56, 3.6%) that were not related to the conduit. All survivors have been evaluated by two-dimensional and Doppler echocardiography, and 29/56 (51.8%) underwent cardiac catheterization. Nine patients (9/56, 16.1%) underwent successful valved conduit replacement, in seven cases with a nonvalved conduit. There was a significant difference (P = .011) with regard to the incidence of conduit replacement between the group with CDC (2/36, 5.5%) and the group with TC (7/19, 36.8%). Five patients underwent percutaneous transluminal balloon dilatation of the prosthetic conduit, with adequate relief of the gradient in four patients.(ABSTRACT TRUNCATED AT 250 WORDS)