Results of an autologous tissue reconstruction for replacement of obstructed extracardiac conduits

Robert J. Cerfolio, Gordon K. Danielson, Carole A. Warnes, Francisco J. Puga, Hartzell V. Schaff, Betty J. Anderson, Duane M. Ilstrup

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Between May 1983 and March 1, 1995, 50 patients had replacement of an obstructed pulmonary ventricle-pulmonary artery conduit with an autologous tissue reconstruction in which a prosthetic roof was placed over the fibrous tissue bed of the explanted conduit. The roof was constructed with xenograft pericardium (most recently) ( n = 42), homograft dura mater ( n = 5), or Dacron fabric ( n = 3). Patient ages ranged from 5 to 34 years (median 16 years). The explanted conduits were Hancock conduits ( n = 33), Tascon conduits ( n = 6), homograft ( n = 4), Dacron tube ( n = 3), and others ( n = 4). Preoperative maximum systolic gradients ranged from 44 to 144 mm Hg (median 78 mm Hg). Thirty-seven concomitant cardiac procedures were done in 29 patients. When a valve was necessary ( n = 15), it was possible to place a large-sized valve in the autologous tissue reconstructions (range 22 to 29 mm, median 26 mm). Cardiopulmonary bypass times ranged from 34 to 223 minutes (median 84 minutes), and aortic crossclamp times ranged from 0 (in 32 patients) to 109 minutes (median 0 minutes). Intraoperative postrepair peak systolic gradients from pulmonary ventricle to pulmonary artery ranged from 0 to 33 mm Hg (median 13 mm Hg). There was one early death (2%) in a patient who had additional cardiac procedures. Follow-up was complete in all patients and ranged from 1 month to 11.8 years (median 7.5 years). There were two sudden late deaths: conduits in both were known to be free from obstruction. Forty-four of the 47 surviving patients had evaluation of the gradient by echocardiography or cardiac catheterization 1 month to 11 years (median 7 years) after operation. The gradients ranged from 5 to 45 mm Hg (median 20 mm Hg). None of the conduits developed an obstructive peel, valve obstruction, or valve incompetence. At 10 years, the freedom from reoperation for conduit obstruction was 100%, and freedom from reoperation for any cause was 81%. This technique simplifies conduit replacement, allows for a generous-sized outflow tract, has a low risk, and yields late results that appear superior to those of cryopreserved homografts or other types of extracardiac conduits. (J THORAC CARDIOVASC SURG 1995;110:1359-68).

Original languageEnglish (US)
Pages (from-to)1359-1368
Number of pages10
JournalThe Journal of thoracic and cardiovascular surgery
Volume110
Issue number5
DOIs
StatePublished - Nov 1995

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Results of an autologous tissue reconstruction for replacement of obstructed extracardiac conduits'. Together they form a unique fingerprint.

Cite this