Document Detail


Right ventricle to pulmonary artery conduit augmentation compared with replacement in young children.
MedLine Citation:
PMID:  19632414     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Targeted outcome data for young children undergoing right ventricle to pulmonary artery conduit reoperation are sparse, as are data on the use of conduit augmentation as an alternative to conduit replacement at the time of first conduit reoperation (conduit 2).
METHODS: We conducted a retrospective chart review including baseline data, operative data, and cross-sectional follow-up on children younger than 10 years of age undergoing a first conduit reoperation (n = 180), comparing conduit replacement (n = 147, 82%) with conduit augmentation (n = 33, 18%).
RESULTS: There were no differences between the two groups with respect to age, size, or hemodynamic variables. Augmentation was less often performed in patients with an aortic homograft and by one surgeon. At conduit 2, cardiopulmonary bypass time was longer in replacement patients (101 +/- 35 versus 71 +/- 34 minutes; p < 0.001); cardiac intensive care unit stay was not different. Early mortality was 0.5%, and overall 10-year survival was 95%. Freedom from reoperation was 80% at 5 years and 39% at 10 years, whereas freedom from reintervention (reoperation or catheter intervention) was 55% at 5 years and 26% at 10 years, with no differences between groups. Aortic homograft as a first conduit was associated with shorter freedom from reoperation. Limiting analysis to conduits that were replaced at conduit 2, undersized conduits were associated with shorter freedom from reoperation and smaller body surface area, and undersized conduits were associated with shorter freedom from reintervention.
CONCLUSIONS: Freedom from a second conduit reoperation after a first conduit replacement was shorter in smaller children and undersized conduits. Conduit augmentation offers similar clinical outcomes in selected patients.
Authors:
Justin P V Zachariah; Frank A Pigula; John E Mayer; Doff B McElhinney
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  88     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-27     Completed Date:  2009-08-21     Revised Date:  2014-08-28    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  574-80     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation*
Child
Child, Preschool
Female
Heart Defects, Congenital / surgery*
Heart Septal Defects, Ventricular / surgery
Heart Ventricles / surgery*
Hemodynamics
Humans
Male
Prosthesis Design
Pulmonary Artery / surgery*
Reoperation / methods
Retrospective Studies
Tetralogy of Fallot / surgery
Truncus Arteriosus / surgery
Ventricular Outflow Obstruction / surgery*
Grant Support
ID/Acronym/Agency:
T32 HL007572/HL/NHLBI NIH HHS; T32 HL007572-24/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Ann Thorac Surg. 2009 Aug;88(2):580   [PMID:  19632415 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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