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Use of larger sized aortic homograft conduits in right ventricular outflow tract reconstruction
R K Tam1, M J Tolan, V Y Zamvar
1Wessex Cardiothoracic Centre, University Hospital, Southhampton, England.
Insights
Aortic homograft valved conduits provide satisfactory results for right ventricular outflow tract reconstruction in congenital heart disease. Larger grafts show a low incidence of reoperation for obstruction at medium-term follow-up.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials in Medicine
Background:
- Congenital heart disease often requires surgical reconstruction of the right ventricular outflow tract (RVOT).
- Aortic homograft valved conduits have been utilized for RVOT reconstruction since the 1970s.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of aortic homograft valved conduits in RVOT reconstruction.
- To assess reoperation rates for obstruction and regurgitation.
Main Methods:
- Retrospective analysis of 60 aortic homograft valved conduits in 56 patients (1 day to 23.5 years) between 1973 and 1993.
- Serial echocardiographic assessments and cardiac catheterizations were performed.
- Follow-up duration ranged from 6 months to 20 years (median 8.6 years).
Main Results:
- Nine hospital deaths and eight late deaths occurred. Survivors (n=45) showed mild-to-moderate homograft regurgitation; 11 had severe regurgitation.
- Freedom from reoperation for conduit obstruction was 98.2% at 5 years and 91% at 10 years.
- Only one of 23 homografts implanted over 10 years ago required replacement due to obstruction; none were replaced for regurgitation.
Conclusions:
- Larger sized aortic homografts in RVOT reconstruction yield satisfactory outcomes.
- A low incidence of reoperation for obstruction is observed at medium-term follow-up.
Abstract:
Between 1973 and 1993 sixty aortic homograft valved conduits in fifty-six patients were used to establish continuity between the right ventricle and the pulmonary artery in congenital heart disease. Age range was one day to 23.5 years (median 3.6 years) which included twenty-six patients less than one-year-old. Conduit size ranged from 11 to 23 mm (median 17.6 mm). there were nine hospital deaths and eight late deaths. The 45 survivors have been followed for a median of 8.6 years (range 6 months to 20 years). All patients have had serial echocardiographic assessments and 35 have had post repair cardiac catheterization. Almost all patients had mild-to-moderate degrees of homograft regurgitation. There were eleven with severe homograft regurgitation and two are being considered for reoperation. The follow up homograft gradient ranged from 0 to 64 mmHg (mean 24 mmHg). Freedom from reoperation for conduit obstruction was 98.2% at five years falling to 91% (C.L. 82%-100%) at 10 years. Of the 23 homografts inserted more than 10 years ago, only one (4.3%) has been replaced because it was causing important obstruction. None have been replaced for regurgitation. Our results indicate that larger sized aortic homografts used in reconstruction of the right ventricular outflow tract give satisfactory results and there is a low incidence of reoperation for replacement at medium term follow up.