Replacement of obstructed extracardiac conduits with autogenous tissue reconstructions.
Tissue-valved prosthetic extracardiac conduits fail in 6% to 30% of patients within 5 years of implantation. Failure is caused both by valve degeneration and by conduit peel formation. This report describes a technique, performed in 16 children, in which an obstructed right ventricle-to-pulmonary artery valved conduit was removed and a new conduit constructed using the conduit bed as the posterior wall and a patch of xenograft pericardium (n = 10), homograft dura mater (n = 5), or Dacron (n = 1) as the roof of the conduit. One child with pulmonary hypertension required a Björk-Shiley pulmonary valve; in the others no valve was inserted. This technique simplifies conduit replacement, allows for a generous-sized outflow tract that may grow with patient growth, and uses material unlikely to become obstructed.
D000293:Adolescent; D000328:Adult; D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000379:methods; D002648:Child; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010496:Pericardium / Q000637:transplantation*; D011651:Pulmonary Artery / Q000601:surgery*; D012086:Reoperation; D014182:Transplantation, Autologous