Fate of equine pericardial roll conduit for Rastelli operation during long-term follow-up.
BACKGROUND
Right ventricular outflow tract obstruction is a frequent condition after Rastelli operation. Although several modifications have been reported elsewhere, ideal conduit has not been developed yet during long-term follow-up. We reviewed our experiences over 15-year long-term follow-up with patients who underwent Rastelli operation using house-made equine pericardial roll graft.


METHODS
Since June 1981, 16 patients underwent Rastelli operation with the pericardial roll graft. Median follow-up time was 15.6 years (7.3-26.8 years).


RESULTS
Twelve out of 16 patients using pericardial roll graft with (n = 6) or without (n = 6) cusps underwent 13 reoperations during the follow-up period. Median time from first Rastelli to re-do operation was 8.4 years with median time to reoperation of 8 years. Major indication for reoperation was conduit obstruction (n = 10), but not conduit regurgitation. Conduit problem includes kinking and compression of the graft. Reoperation procedures include 7 Danielson procedures, 2 patch augmentations, 1 homograft replacement, 1 pericardial roll graft, 1 expanded polytetrafluoroethylene tube graft replacement, and 1 patch closure for pulmonary artery aneurysm. Balloon angioplasty was not effective for pericardial roll conduit stenosis.


CONCLUSIONS
We conclude that house-made equine pericardial roll graft was durable for certain time period, but conduit change may be inevitable. Because of excellent handling and wide application, further modification may be warranted.
Takeuchi
Koh
K
Department of Cardiac Surgery, University of Tokyo Graduate of Medical School, Tokyo, Japan. koutakeuchi-circ@umin.ac.jp
Murakami
Arata
A
Sekiguchi
Akihiko
A
Hirata
Yasutaka
Y
Maeda
Katsuhide
K
Kitahori
Kazuo
K
Doi
Yoshio
Y
Takamoto
Shin-ichi
S
D000293:Adolescent; D000328:Adult; D000818:Animals; D001705:Bioprosthesis / Q000009:adverse effects; D006348:Cardiac Surgical Procedures; D005500:Follow-Up Studies; D006736:Horses; D006801:Humans; D053208:Kaplan-Meier Estimate; D010496:Pericardium; D011138:Polytetrafluoroethylene; D019736:Prostheses and Implants; D012086:Reoperation; D013997:Time Factors; D014694:Ventricular Outflow Obstruction / Q000601:surgery*
D011138:Polytetrafluoroethylene