Apico-aortic conduits in children with severe left ventricular outflow tract obstruction.
BACKGROUND
Infrequently, congenital heart defects are complicated by left ventricular outflow tract obstruction (LVOTO) not amenable to conventional reconstruction. Apico-aortic conduits provide a means of palliating such patients until definitive repair is possible. The purpose of this study was to review a single institution's current experience with apico-aortic conduits.


METHODS
The medical records of pediatric patients receiving apico-aortic conduits were reviewed. Demographics, operative techniques, preoperative and postoperative physiologic variables, morbidity, mortality, and functional class were recorded. Off-pump and on-pump procedures were categorized for comparison.


RESULTS
Ten cases of apico-aortic conduits for left ventricular outflow tract obstruction were identified. Indications included congenital aortic stenosis, aortic atresia, and subaortic stenosis. Six procedures were performed off-pump and four required median sternotomy with cardiopulmonary bypass as necessitated by concomitant procedures. There was one operative death. The remaining patients demonstrated hemodynamic improvements and are all alive to date. One patient required conduit valve replacement. All patients are in New York Heart Association classification I or II at the time of last follow-up.


CONCLUSIONS
Apico-aortic conduits provide a safe and effective treatment alternative for select cases of left ventricular outflow tract obstruction. Off-pump techniques are feasible in the majority of cases. This valuable adjunct should be considered whenever conventional repair of left ventricular outflow tract obstruction is considered prohibitive.
Khanna
Sohit K
SK
Division of Cardiothoracic Surgery, Medical College of Georgia, Augusta 30912, USA.
Anstadt
Mark P
MP
Bhimji
Shabir
S
Bannan
Mary M
MM
Mawulawde
Kwabena
K
Zumbro
G Lionel
GL
Moore
H Victor
HV
D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000601:surgery*