Establishing right ventricle-pulmonary artery continuity by autologous tissue: an alternative approach for prosthetic conduit repair.
BACKGROUND
In conventional conduit operations, longevity has been essentially limited by the inevitable need for conduit replacement. This study was undertaken to compare long-term results of the use of equine pericardial conduits, autologous pericardial conduits, and direct anastomosis repair.


METHODS
Between 1982 and 2001, 366 patients underwent primary establishment of right ventricle-pulmonary artery continuity at our institution. The mean age at the time of operation was 6.2 years (range, 4 days to 28 years) and mean weight was 17.2 kg (range, 1.6 to 61 kg). Three different repair techniques were used for connection: hand-made valved equine pericardial conduits (n = 179), autologous pericardial conduits (n = 71), and direct anastomosis without a conduit (n = 116). Mean follow-up period for early survivors was 8.6 years in the equine group, 6.1 years in the direct anastomosis group, and 5.1 years in the autologous pericardium group.


RESULTS
Direct anastomosis repair (p = 0.0002) was associated with significantly better freedom from late events (conduit replacement or late death) than equine pericardial conduits. The hazard ratio was less with the autologous pericardium conduit than with the equine pericardium, but the difference was not statistically significant (p = 0.2122). Younger age at operation, and postoperative pressure ratio from right to left ventricle were also predictors of conduit longevity.


CONCLUSIONS
To decrease the probability of late events, direct anastomosis is an encouraging technique compared with traditional equine pericardium extracardiac conduit repair. An autologous pericardial conduit, because of its benefits, would be an alternative when direct anastomosis is not suitable.
Isomatsu
Yukihisa
Y
Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Japan. isomatsu@med.yokohama-cu.ac.jp
Shin'oka
Toshiharu
T
Aoki
Mitsuru
M
Terada
Masatsugu
M
Takeuchi
Takamasa
T
Hoshino
Shuichi
S
Takanashi
Yoshinori
Y
Imai
Yasuharu
Y
Kurosawa
Hiromi
H
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D000818:Animals; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D004310:Double Outlet Right Ventricle / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000601:surgery*; D006736:Horses; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010496:Pericardium; D011093:Polyethylene Terephthalates; D011183:Postoperative Complications / Q000453:epidemiology; D011651:Pulmonary Artery / Q000601:surgery*; D018633:Pulmonary Atresia / Q000601:surgery; D016019:Survival Analysis; D013771:Tetralogy of Fallot / Q000601:surgery; D014182:Transplantation, Autologous; D014188:Transposition of Great Vessels / Q000601:surgery; D014338:Truncus Arteriosus / Q000601:surgery; D016278:Ventricular Function, Right
D011093:Polyethylene Terephthalates