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Long-term follow-up of autologous pericardial valved conduits
A J Schlichter1, C Kreutzer, R C Mayorquim
1Division of Pediatric Cardiac Surgery and Cardiology, Hospital de Niños Ricardo Gutierrez, Buenos Atres, Argentina.
Insights
Autologous pericardial valved conduits show excellent long-term results for congenital heart malformations. Survival free of reoperation was high, especially for larger conduits, comparing favorably with alternatives.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Congenital heart malformations require surgical intervention, often involving outflow tract reconstruction.
- Autologous pericardial valved conduits offer a potential solution for venous ventricle outflow tract reconstruction.
Purpose of the Study:
- To evaluate the long-term efficacy and durability of autologous pericardial valved conduits.
- To assess factors influencing reoperation rates and conduit survival.
Main Methods:
- A cohort of 51 patients with congenital heart malformations received autologous pericardial valved conduits.
- Long-term follow-up (12-120 months) included clinical evaluation, echocardiography, and pressure gradient measurements.
- Statistical analysis of reoperation rates based on conduit size, postoperative time, and malformation type.
Main Results:
- Conduit diameter increased in 27 patients, remained stable in 20, and decreased in 4.
- Overall conduit survival free of reoperation was 89.9% at 5 years.
- Conduits >16 mm at implantation showed 100% survival free of reoperation at 5 and 7 years; smaller conduits had 72.3% survival at 7 years.
Conclusions:
- Autologous pericardial valved conduits demonstrate favorable long-term outcomes in congenital heart surgery.
- Conduit size at implantation is a critical factor for long-term success and reduced reoperation rates.
- These results suggest comparable or superior performance to other available conduit options.
Background:
The aim of this study was to evaluate the long-term results of the use of an autologous pericardial valved conduit in the outflow tract of the venous ventricle in congenital heart malformations.
Methods:
Fifty-one patients were followed up for a period of 12 to 120 months; 30 for more than 36 months and 13 for more than 72 months. All were evaluated clinically and by two-dimensional and Doppler echocardiography. Eight patients were recatheterized. Postoperative evaluation included serial measurement of pressure gradients and the conduit's diameter at the proximal, valvular, and distal levels. Reoperation because of stenosis was indicated when the gradient across the right ventricular outflow was greater than 50 mm Hg. The reoperation rate in relation with postoperative time, diameter of the autologous pericardial valved conduit at the time of implantation, and malformation was statistically analyzed.
Results:
In 27 patients the conduit increased its diameter 1 to 7 mm. In 20 patients the diameter remained unchanged, whereas a reduction was noted in 4. Conduit survival free of reoperation for the whole group was 89.9% at 5 years. Conduit survival free of reoperation was 100% at 5 and 7 years for conduits larger than 16 mm at the time of implantation. It was 95% (standard deviation = 4.8%) at 5 years and 72.3% at 7 years for those 16 mm or less. For patients operated after January 1, 1986 (technical modification), conduit survival free of reoperation was 95.4% at 7 years postoperatively.
Conclusions:
These results compare favorably with those of other available conduits.