The fate of antibiotic sterilized aortic allografts in Fontan circulation: results of the long-term follow-up.
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.
Kiraly
L
L
Department of Cardiothoracic Surgery, Southampton General Hospital, Southampton, UK.
Dalrymple-Hay
M J
MJ
Salmon
A P
AP
Keeton
B R
BR
Monro
J L
JL
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001013:Aorta, Thoracic; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000401:mortality; D006085:Graft Survival; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D009926:Organ Preservation / Q000379:methods*; D011247:Pregnancy; D012086:Reoperation; D012189:Retrospective Studies; D013242:Sterilization / Q000379:methods*; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents