Related Experiment Videos
Left ventricle-aortic conduits in pediatric patients
Insights
Left ventricle-aortic conduits effectively relieve outflow obstruction in pediatric patients. However, high rates of reoperation due to valve failure indicate potential long-term complications.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Severe left ventricular outflow tract obstruction requires surgical intervention.
- Porcine valved conduits have been used to address these obstructions.
Purpose of the Study:
- To evaluate the efficacy and long-term outcomes of left ventricle-aortic porcine valved conduits in pediatric patients.
- To compare outcomes between younger (<2 years) and older (2-14 years) pediatric groups.
Main Methods:
- Retrospective analysis of 13 pediatric patients who received left ventricle-aortic porcine valved conduits between 1974 and 1982.
- Surgical techniques included direct left ventricle connection or use of a right-angle connector, with distal anastomosis to ascending or abdominal aorta.
Main Results:
- All patients achieved relief of left ventricle-aortic gradients (mean residual gradient = 4.3 mm Hg).
- Mortality was 100% in the younger group (<2 years) and 10% in the older group (2-14 years).
- 78% of survivors required reoperation for conduit valve failure or related complications, with one patient needing a second reoperation.
Conclusions:
- Left ventricle-aortic conduits offer immediate relief of left ventricular outflow tract obstruction.
- High incidence of late complications necessitates consideration of alternative procedures like aortoventriculoplasty (Konno) for potentially better long-term results.
Abstract:
From August, 1974, to January, 1982, left ventricle-aortic porcine valved conduits were inserted in three patients less than 2 years old (Group 1) and in 10 patients between 2 and 14 years of age (Group 2) for relief of severe left ventricular outflow tract obstruction. The distal anastomosis was made to the ascending aorta in seven patients and to the supraceliac abdominal aorta in six patients. In six patients, the conduit was sutured directly to the left ventricle, and in seven a stented right-angle connector was employed. The left ventricle-aortic gradients were relieved in all cases (mean residual gradient = 4.3 mm Hg). All three patients in Group 1 had associated endocardial fibroelastosis and all died. There was one early death in Group 2 (10% mortality). Reoperation was required in seven of nine survivors (78%) 2.7 to 5.2 years postoperatively for conduit valve failure (five patients), progression of mild native aortic valve insufficiency (one patient), or both (one patient). One of the seven required another reoperation for re-replacement of the conduit valve. There was one late death associated with reoperation. At follow-up 3.4 to 7.5 years postoperatively, four patients are in Functional Class I, two are in Class II, and two are convalescing from reoperation. Left ventricle-aortic conduits provide excellent relief of left ventricular outflow tract obstruction. However, the high incidence of late complications suggests better results might be anticipated with aortoventriculoplasty (Konno).