LONG-TERM CLINICAL AND HEMODYNAMIC EVALUATION OF PORCINE VALVED CONDUITS IMPLANTED FROM THE RIGHT VENTRICLE TO THE PULMONARY ARTERY

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Abstract

Objective:

This retrospective study was initiated to evaluate the long-term results of valved prosthetic conduits implanted in the right ventricular outflow tract in patients with complex ventricular-pulmonary discontinuity.

Methods:

A cohort of 103 patients out of 127 (24 early deaths, 19%) operated on between 1973 and 1996 with porcine valved conduits was available for evaluation, with a follow-up ranging from 1 to 21.6 years (mean follow-up 8.4 ± 6 years). A total of 74 hemodynamic studies were performed after the operation, 50 patients having undergone at least 1 cardiac catheterization during the follow-up period.

Results:

There were 16 late deaths, and the actuarial survivals, including early mortality, were 72.9% ± 4% at 5 years, 63.1% ± 5% at 10 years, and 58.2% ± 5% at 15 years, at which time 20 patients were still available for review and exposed to the risk of dying. The mean peak systolic gradient across the right ventricular outflow tract was plotted as a function of time, showing a gradual increase and a significant step-up after the eighth year, from 43 ± 36 to 69 ± 19 mm Hg (P < .005). Reoperation was required for progressive conduit obstruction between 1.1 and 17.7 years after implantation (mean 7.4 ± 4.8 years) in 25 patients (24%, 70% CL 15%-33%), with generally very few symptoms, or for residual ventricular septal defect in 3 patients. Freedom from reoperation was 79.5% ± 5% at 10 years and 65.8% ± 7% at 15 years.

Conclusions:

Porcine conduits may represent a valuable alternative to biologic substitutes with similar long-term results. Given the few symptoms, progressive conduit stenosis after the eighth postoperative year imposes a yearly noninvasive patient evaluation during the follow-up.

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