Intermediate and Long Term Results for Extracardiac Conduit Repair Between Right Ventricle and Pulmonary Artery in Congenital Cardiac Defect

선천성 심장기형의 우심실-폐동맥 인조혈관 연결 수술후 중장기 성적

  • Published : 1995.06.01

Abstract

Rastelli operation in which right ventricle[RV and pulmonary artery[PA is connected with an artificial graft is effective in increasing the pulmonary blood flow in certain types of congenital heart disease but, in many, it requires a reoperation because of the relative stenosis of graft that develops as the patients become old. The purpose of this study is to evaluate the various factors which many influence the long term outcome of such patients following a Rastelli operation. A total of 47 patients underwent a Rastelli operation during a 15 year period between November, 1978 and October 1993. The mean follow-up period is 76.1 51.3 months.1 Among the 47 patients, a valved conduit was used in 30[63.8% , and non-valved conduit in 17[36.2% patients. In the 8 patients[17.0% who died postoperatively, a valved conduit was used in 5 [16.6% and a non-valved conduit in 3[17.6% . There was no statistical difference in mortality between the 2 groups. There was a good linear correlation between the body surface area[X and the conduit size[Y [Y=3.86X + 14.6, R=0.55, P=0.01 .2 Ten patients underwent replacement of the conduit during the follow-up period. The type of conduit used and the frequency of subsequent replacement were as follows: Ionescu-Shiley, valved-33.3%, Carpentier-Edwards, valved-30.8%, Hancock, valved-80% and non-valved conduit-9.1%. The median period free of reoperation was 110 months for the valved and 79 months for the non-valved group, there being no statistical difference between the 2 groups. 3 The patients who did not require reoperation are all doing well [New York Heart Association Functional Classification: Class I . Pressure gradient between the RV and the PA was 20 mmHg in 10 randomly selected patients who did not require reoperation and 92 9 mmHg in 10 patients who did require reoperation.4 In the 10 patients who underwent a conduit replacement procedure.5 Among patients undergoing reoperation, 2 died from endocarditis.The remaining 8 patients are doing well without limitation in physical activity at a mean follow-up period of 32.7 33.9 months [range 2 to 89 months . 6 At 5, 7, and 10 years, the reoperation-free rates among all patients were 96%, 91% and 29% and the survival rates were 82%, 82% and 71%. In conclusion, Rastelli operation is an effective procedure in ameliorating symptoms in a select group of patients with congenital heart disease. Because of the inherent nature of relative graft stenosis and degeneration, a long-term follow-up is required under the proper selection of the graft material.

Keywords

References

  1. J Thorac Cardiovasc Surg v.58 1. Anatomic correction of trasposition of the great arteries with ventricular septal defect and subpulmonary stenosis Rastelli,C.G.;McGoon,D.C.;Wallace,R.B.
  2. Am J Cardiol v.49 Late results after extracardiac conduit repair ofr congenital cardiac defects McGoon,D.C.;Danielson,G.K.;Puga,F.J.;Ritter,D.G.;Mair,D.D.;Ilstrup,D.M.
  3. J Thorac Cardiovasc Surg v.88 Reoperation for obstructed pulmonary ventricle-pulmpnary artery conduits Shaff,H.V.;DiDonato,R.M.;Danielson,G.K.;Puga,F.J.;Ritter,D.G.;Edwards,W.D.;McGoon,D.C.
  4. Circulation v.72 no.Ⅱ Long-term follow-up of patients with synthetic right heart conduits Jonas,R.A.;Freed,M.D.;Mayer,J.E.;Casteneda,A.R.
  5. J Thorac Cardiovasc Surg v.94 Evaluation of long-term results of homograft and heterograft valves in extracardiac conduit Bull,C.;Macartney,F.J.(et al.)
  6. J Thorac Cardiovasc Surg v.103 Tracsposition of the great arteries, ventricular septal defect, and pulmonary outflow tract obstruction. Rastelli or Lecompte procedure? Vouhe',P.R.;Tamisier,D.;Leca,F.;Ouaknine,R.;Vernant,F.;Neveux,J.Y.
  7. Arch Surg v.107 A valve-containing Dacron prosthesis Bowman,F.O.;Hancock,W.D.;Malm,J.R.
  8. J Thorac Cardiovasc Surg v.78 Experience with extracardiac conduit Ciaravella,J.M.;McGoon,D.C.;Danielson,G.K.;Wallace,R.B.;Mair,D.D.
  9. Ann Surg v.204 Surgical treatment of truncus arteriosus in the first 6 momths of life Ebert,P.A.;Turley,K.;Stanger,P.;Hoffman,J.E.;Heymenn,M.A.;Rudolph,A.M.
  10. J Thorac Cardiovasc Surg v.88 A new method for the quantitative standardization of cross sectional area of the pulmonary arteries in congenital heart disease with decreasd pulmonary blood flow Nakada,S.;Imai,Y.;Takanashi,Y.(et al.)
  11. Ann Thorac Surg v.55 Fate of small homograft conduits after early repair of truncus arteriosus Heinemann,M.K.;Hanley,F.L.;Fenton,K.N.;Jonas,R.A.;Mayer,J.E.;Castaneda,A.R.
  12. Circulation v.56 no.SUP.Ⅰ LAte results with valved external conduit from venous ventricle to pulmonary arteries Baliey,W.W.;Kirklin,J.W.;Bargeron,L.M.;Pacifico,A.D.;Kouchoukos,N.T.
  13. Ann Thorac Surg v.31 Late results of reconstruction of right ventricular outflow tract with porcine xenograft in children Bisset Ⅲ,G.S.;Schwartz,D.C.;Benzing Ⅲ,G.;Helmswort,J.;Schreiber,J.T.;Kaplan,S.
  14. Ann Thorac Surg v.40 Fifteens' experience with the aortic homograft. The conduit of choice for right ventricular outflow tract reconstruction Kay,P.H.;Ross,D.N.
  15. J Thorac Cardiovasc Surg v.95 The fate of the 12mm porcine valved conduit from the right ventricle to the pulmonary artery Boyce,S.W.;Turley,K.;Yee,E.S.;Verrier,E.D.;Ebert,P.A.
  16. Ann Thorac Surg v.52 Extracardiac valved conduit in the pulmonary conduit Sano,S.;Karl,T.R.;Mee,R.B.
  17. Circulation v.72 no.SUP.Ⅱ Replacement of obstructed right ventricularpulmonary arterial valved conduits with nonvalved conduits in children Downing,T.P.;Danielson,G.K.;Schaff,H.V.;Puga,F.J.;Edwards,W.D.;Driscoll,D.J>
  18. Circulation v.72 Conduit repair for complex congenital heart disease Heck,H.A.;Schieken,R.M.;Lauer,R.M.;Doty,D.B.