Document Detail


The fate of antibiotic sterilized aortic allografts in Fontan circulation: results of the long-term follow-up.
MedLine Citation:
PMID:  10647837     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Between 1977 and 1988, 27 patients, mean age 8.9 (range 4-22) received an antibiotic sterilised aortic allograft in the setting of the Fontan procedure. This study describes the long-term follow-up of these patients. METHODS: Fifteen patients had tricuspid atresia, nine double inlet ventricles and three others. The connection with the allograft was made to the pulmonary artery on the right side of the aorta in ten and to a left-sided main pulmonary artery in eight. In nine patients the allograft was anastomosed between the right atrium and the right ventricle. RESULTS: There were five early and five late deaths. One late death may have been allograft related. Survival was 81, 74 and 68% at 5, 10 and 15 years, respectively. Conduit calcification was universal. Twelve patients underwent reoperation, freedom from reoperation was 100, 88 and 54% at 5, 10 and 15 years following the initial Fontan procedure. At reoperation the gradient across the allograft was never more than 3 mmHg. The allograft was explanted with conversion to atriopulmonary or cavopulmonary connection in nine and a second allograft was inserted between the right atrium and right ventricle in two. No mortality occurred at reoperation. 41.1% of survivors still have their original allograft. CONCLUSIONS: Although there is a significant attrition rate allograft inclusion in the Fontan circulation does not change survival, but results in an increased reoperation rate. Inclusion of a valved conduit between the right atrium and ventricle does not usually enhance the growth potential of the rudimentary ventricle. All patients are in a good functional class which may represent the strict original selection criteria. The inclusion of a valve in the Fontan circulation is not recommended.
Authors:
L Kiraly; M J Dalrymple-Hay; A P Salmon; B R Keeton; J L Monro
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  16     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  1999 Dec 
Date Detail:
Created Date:  2000-02-09     Completed Date:  2000-02-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  660-2     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, Southampton General Hospital, Southampton, UK.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anti-Bacterial Agents / pharmacology*
Aorta, Thoracic*
Blood Vessel Prosthesis Implantation / methods*,  mortality
Child
Child, Preschool
Female
Follow-Up Studies
Fontan Procedure* / mortality
Graft Survival
Heart Defects, Congenital / surgery*
Humans
Organ Preservation / methods*
Pregnancy
Reoperation
Retrospective Studies
Sterilization / methods*
Survival Rate
Transplantation, Homologous
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

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


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