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J Thorac Cardiovasc Surg 1997;113:425
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Truncus arteriosus repair: Influence of techniques of right ventricular outflow tract reconstruction

Chief, Division of Cardiac Surgery
Hospital de Niños
Buenos Aires, Argentina

To the Editor:

I was pleased to read the recently published article by Lacour-Gayet and associates ¹ regarding truncus arteriosus. The implications of different technical approaches used for right ventricular–pulmonary artery outflow reconstructions on the immediate, midterm, and long-term results are widely known. In this study, the authors used different types of conduits and a direct anastomosis to establish right ventricular–pulmonary artery continuity. In five patients, a fresh autologous pericardial valved conduit was used, manufactured according to the description published by my colleague Schlichter and me. ^2-4 It is not surprising to us that 100% of survivors in whom this technique was used did not require conduit replacement in more than 6 years of follow-up. In our experience ^{4, 5} in more than 50 patients followed up for 1 to 10.4 years (median 5 years), the conduit implant's freedom from reoperation was 90% at 5 years and 100% for those that measured more than 16 mm at the time of implantation. It is hard to believe that the 40% immediate mortality in two of five patients treated by this technique was purely related to the pericardial valved conduit and to severe pulmonary regurgitation. Both patients who died had interrupted aortic arch, one of whom was 2 days of age at the time of repair, and young age under 30 days is recognized by the authors as a risk factor. In addition, the diagnosis of severe pulmonary regurgitation in the reported two patients is surprising, because we have not registered any case of moderate or severe postoperative pulmonary regurgitation during the immediate postoperative period. Furthermore, no considerations are made with respect to possible technical problems during tailoring of the conduit. To achieve success, the constructor must be extremely careful and follow all the steps precisely, as they were described. ^2,3

We continue to believe that the autologous pericardial valved conduit is an effective, cheap, and highly successful option for the Rastelli repair or even the Ross procedure when no previous pericardial adhesions are present. We concur with the authors' observation on the advantageous capability of the autologous pericardial valved conduit to grow with time.

12/8/77398

References

1. Lacour-Gayet F, Serraf A, Komiya T, Sousa-Uva M, Bruniaux J, Touchot A, et al. Truncus arteriosus repair: influence of techniques of right ventricular outflow tract reconstruction. J Vasc Surg 1996;111:849-56.
   
2. Schlichter A, Kreutzer GO. Autologous pericardial valved conduit. Rev Latina Cardiol Cir Cardiovasc Infanfil 1985;1:43-8.
   
3. Kreutzer GO. Discussion of Brown et al. Externally stented polytetrafluoroethylene valved conduits for right heart reconstruction. J Vasc Surg 1985;90:841.
   
4. Schlichter AJ, Kreutzer C, Mayorquim RC, Simon JL, Vazquez H, Roman M, et al. Long-term follow-up of autologous pericardial valved conduits. Ann Thorac Surg 1996;62:155-60.[Abstract/Free Full Text]
   
5. Kreutzer GO. Discussion of Cerfolio et al. Results of an autologous tissue reconstruction for replacement of obstructed extracardiac conduits. J Vasc Surg 1995;110:1359-68.
   

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Guillermo O. A. Kreutzer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kreutzer, G. O. A. Search for Related Content PubMed PubMed Citation Articles by Kreutzer, G. O. A.