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Durability of large diameter right ventricular outflow tract conduits in adults with congenital heart disease.
MedLine Citation:
PMID:  25002319     Owner:  NLM     Status:  Publisher    
BACKGROUND: Subpulmonary ventricular outflow conduits are utilized routinely to repair complex congenital cardiac abnormalities, but are limited by the inevitable degeneration and need for reintervention. Data on conduit durability and propensity to dysfunction in the adult population are limited.
METHODS: The study included 288 consecutive patients ≥18years of age who were evaluated between 1991 and 2010 after placement of a ≥18mm conduit. Freedom from hemodynamic conduit dysfunction served as our primary outcome. Freedom from reintervention, overall mortality and heart transplantation were also evaluated.
RESULTS: Median age at conduit implant was 19years and median follow-up duration was 13years. Probabilities of survival without conduit dysfunction and reintervention at 5, 10 and 15years were 87%, 63%, and 49%, and 95%, 81%, and 56%, respectively. Smaller conduit diameter (18-20mm) was associated with lower probability of survival without dysfunction in the entire study cohort, with prominent effects in patients in both the lowest and the highest age quartiles. Other parameters with similar associations were higher BMI, native anatomy of tetralogy of Fallot or truncus arteriosus, and active smoking.
CONCLUSIONS: Adult congenital heart disease patients with conduit diameter ≥18mm had an approximately 50% chance of developing hemodynamic conduit dysfunction and undergoing conduit reintervention by 15years of post-implant, and a 30% likelihood of undergoing conduit reoperation in the same time frame. The importance of these data is underscored by the increasing number of adults with congenital heart diseases seeking care and the recent advances in transcatheter valve replacement for dysfunctional conduits.
Jonathan Buber; Gabriele Egidy Assenza; Alice Huang; Anne Marie Valente; Sitaram M Emani; Kimberlee Gauvreau; Audrey C Marshal; Doff B McElhinney; Michael J Landzberg
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-6-28
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2014 Jun 
Date Detail:
Created Date:  2014-7-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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