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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 228-235, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JD Albert, DA Bishop, DA Fullerton, DN Campbell and DR Clarke
From September 1979 to July 1991, a total of 163 patients have undergone
valved conduit reconstruction of the right ventricular outflow tract when a
right ventricle-pulmonary artery connection was absent or right ventricular
outflow tract enlargement was required. From September 1979 through October
1984, 24 porcine valved conduits were implanted with an operative mortality
of 38% (9/24). There were no early failures, but by 9 years after the
operation 9 of 15 survivors (60%) had severe conduit obstruction, which
resulted in death in 2 patients and reoperation in 6. From May 1985 to June
1991, 24 patients received cryopreserved aortic allografts to correct
congenital anomalies. Operative mortality was 25% (6/24) and, again, early
conduit function was good. There were 4 (22%) late deaths that were not
related to the aortic allograft. At a mean follow-up of 3.4 years, 11 of
the 13 survivors (85%) had allograft calcification and 8 of the 13 (62%)
had mild to moderate conduit stenosis or regurgitation, or both; two of
them required conduit replacement. Distal anastomotic problems that might
have been avoided with bifurcated pulmonary allografts were apparent in 4
(36%) patients. Cryopreserved pulmonary allografts were placed in 115
patients between April 1985 and January 1991, with 18 (16%) operative
deaths. Late deaths that were not allograft related occurred in 7 of 97
surviving patients (7%). Six patients (6%) underwent reoperation, 2 because
of primary pulmonary allograft failure. The 84 remaining patients are free
of symptoms with little or no allograft calcification or echocardiographic
evidence of significant conduit stenosis or regurgitation. Experience with
porcine valved conduits and aortic and pulmonary allografts suggests that
pulmonary allografts are the conduit of choice for right ventricular
outflow tract reconstruction.
ARTICLES
Conduit reconstruction of the right ventricular outflow tract. Lessons learned in a twelve-year experience
Childrens Hospital, University of Colorado Health Sciences Center, Denver.
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