The equine pericardial valved conduit and current strategies for pulmonary reconstruction

In the period from 1976 to February 1995, 268 cases underwent extracardiac conduit repair (ECR), or direct reconstruction of the pulmonary artery. Of these 268 patients, 64 had a valved Dacron conduit, 143 received handmade valved equine pericardial conduits (Xenomedica), 24 had autologous fresh pericardial conduits, and 37 cases had pulmonary artery reconstruction by direct anastomosis without the use of tubular conduits. Hospital mortality in each group showed gradual improvement chronologically; 20.3% in the Dacron group, 9.8% in the equine conduit group, 4.2% in the autologous pericardial conduit group, and 5.4% in the direct anastomosis group, and the mortality rate was significantly higher in the Dacron group (P = .0261). Late death was seen in 7 of 51 (13.7%) in the Dacron group, 12 of 129 (9.3%) in the equine group, 1 of 23 (4.3%) in the autologous pericardial conduit, and none in the direct anastomosis group (P = .1263). Actuarial survival rates of the patients in the Dacron and equine conduit groups showed better survival in the latter without statistical significance: 75.0%, 83.2% at 5 years, and 69.7%, 80% at 10 years, respectively. However, actuarial survival rates among short-term survivors in the Dacron and equine conduit groups remained the same: 87.5%, and 88.7% at 10 years. Our current strategy in this entity is autologous tissue reconstruction of the pulmonary artery either by direct anastomosis or autologous pericardial conduit. Of 30 cases with transposed great arteries or truncus arteriosus, direct anastomosis could be performed in 19 (63.3%) since January 1992.(ABSTRACT TRUNCATED AT 250 WORDS)