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The Annals of Thoracic Surgery, Vol 52, 285-290, Copyright © 1991 by The Society of Thoracic Surgeons
S Sano, TR Karl and RB Mee
Extracardiac valved conduits represent one of the weakest facets of
reconstructive surgery for congenital heart disease in that they invariably
need to be replaced because of growth of the patient or because of valve or
conduit failure. Between 1979 and 1989, 141 patients had 169 valved
conduits placed between the heart and the pulmonary artery circuit. There
were 81 male and 60 female patients, aged 2 days to 35 years (mean age, 5.9
years), with 46 patients less than 1 year of age. We performed primary
repair in 117 patients; in this group, there have been 28 conduit
replacements in 27 patients. In 17 patients initial repair with a conduit
was performed elsewhere and we replaced these conduits in 15 and removed
them in 2. A further group of 9 patients were seen after repair of
tetralogy of Fallot or double- outlet right ventricle, with severe
pulmonary incompetence or right ventricular outflow tract aneurysm. All had
valved conduits inserted as secondary procedures. The types of valved
conduits used were xenograft (n = 126) and homograft (n = 43). There were
six hospital deaths (3.6%; 70% confidence limits [CL], 2% to 6%) and seven
late deaths (4.1%; CL, 2.5% to 6.5%) in a total of 169 conduit insertions.
Forty-five conduits have been removed and 43 reinserted without early or
late mortality (0%; CL, 0% to 4%). Actuarial survival after conduit
insertion was 87% at 5 years (CL, 80% to 92%), including operative
mortality. Actuarial freedom from conduit replacement was 37% at 5 years
(CL, 20% to 56%). Conduit insertion in infants and small children ensures
subsequent replacement, but this can be done at low risk.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Extracardiac valved conduits in the pulmonary circuit
Victorian Paediatric Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, Australia.
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