Midterm follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure.
OBJECTIVE
Extracardiac conduit Fontan procedure has some theoretical advantages over other types of Fontan procedures, such as optimized flow dynamics, a lower frequency of arrhythmias, and technical ease of procedure. However, lack of growth potential and thrombogenicity of the artificial conduit is the main concern and can possibly lead to reoperation for the conduit stenosis. In this study, we investigated the change and the status of the Gore-Tex graft used in extracardiac conduit Fontan procedure.


METHODS
Between 1996 and 2005, 154 patients underwent extracardiac conduit Fontan procedure using Gore-Tex graft. Among these, 46 patients underwent cardiac catheterization during follow-up period. We measured the internal diameter of the conduit and inferior vena cava angiographically.


RESULTS
Mean follow-up duration was 36.1+/-19.7 months. The conduit diameter used was 16 mm in 10 patients, 18 mm in 16, 20 mm in 14, 22 mm in 4, and 24 mm in 2 patients. The mean conduit-to-inferior vena cava cross-sectional area ratio was 1.25+/-0.33. According to the conduit size used, this ratio was 1.03+/-0.17 for 16 mm conduits, 1.33+/-0.37 for 18 mm, 1.33+/-0.36 for 20 mm, 1.28+/-0.26 for 22 mm, and 1.05+/-0.06 for 24 mm conduits (p<0.05, 16 mm vs 18 mm and 20 mm). The mean percent decrease of the conduit cross-sectional area was 14.3+/-8.5%, and this did not differ significantly according to the conduit size (p=0.82). Follow-up duration and the percent decrease of the conduit cross-sectional area did not show significant correlation (r=0.22, p=0.14). There was no reoperation due to conduit stenosis.


CONCLUSIONS
During midterm follow-up of about 3 years, the conduit cross-sectional area decreased by 14%, and this did not differ according to the conduit size used. The extent of decrease of the conduit cross-sectional area remained stable irrespective of the follow-up duration. Sixteen millimeters conduit showed no evidence of clinically significant stenosis, but careful follow-up is warranted because of the possible conduit stenosis relative to the patients' somatic growth.
Lee
Cheul
C
Department of Thoracic and Cardiovascular Surgery, Sejong Heart Institute, Sejong General Hospital, 91-121 Sosa Bon 2-dong, Sosa-ku, Bucheon-shi, Kyungki-do 422-232, South Korea.
Lee
Chang-Ha
CH
Hwang
Seong Wook
SW
Lim
Hong Gook
HG
Kim
Soo-Jin
SJ
Lee
Jae Young
JY
Shim
Woo-Sup
WS
Kim
Woong-Han
WH
D000293:Adolescent; D000328:Adult; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000295:instrumentation* / Q000379:methods; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D008297:Male; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D012189:Retrospective Studies
D011138:Polytetrafluoroethylene