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The Journal of Thoracic and Cardiovascular Surgery, Vol 78, 920-930, Copyright © 1979 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JM Ciaravella Jr, DC McGoon, GK Danielson, RB Wallace, DD Mair and DM Ilstrup
A review is made of all Mayo Clinic cases wherein 468 patients have
received 516 extracardiac conduits in the repair of congenital heart
defects. All patients had complex defects, which are classified in 10 basic
diagnostic categories. The early mortality rate (which ranged from 4% to
49%, according to diagnostic group) averaged 25%, improving with
experience. The postoperative complication rate was 70%. In 1% of
operations, compression of the conduit was encountered at chest closure.
The conduits placed in 333 patients contained a porcine valve. The conduit
diameter averaged 22 mm. At completion of the operation, the mean gradient
across the conduit was 22.8 mm Hg. At late study this mean gradient
remained at 26 mm Hg in patients who had received the currently employed
porcine-valved conduit. The average ratio of intraoperative postrepair
ventricular (RV/LV) systolic pressures was 0.68. It was lower among the
group who were to survive but was not ov prognostic value in individual
cases. Among patients who survived the postoperative period, the late
mortality rate (based on a mean of 3.6 years' follow-up) averaged 3.5% per
year. Of the long-term survivors, 18% have required reoperation, primarily
for replacement of calcified aortic homograft conduits used in the earlier
part of the experience. Only 0.8% of porcine-valved conduits have required
reoperation. Unrestricted life-styles were possible for 90% of survivors.
ARTICLES
Experience with the extracardiac conduit
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