Subscribe to RSS
DOI: 10.1055/s-0041-1725696
Mid-Term Fate of Small-Size RVPA Conduits
Objectives: Reconstruction of the RVOT in neonates and small infants often requires implantation of small size RVPA conduits that are prone to fail by degeneration and outgrowth in the mid or long term. This study aimed to identify risk factors for early conduit failure and mortality.
Methods: This retrospective single-center investigation analyzed the postoperative outcome of n = 62 patients who received small size RVPA conduits between 2000 and 2019. The majority (80.6%) of these patients were infants (age < 1 year) at the time of conduit surgery; median age and weight were 7.6 months and 6.6 kg. The internal diameter of implanted RVPA conduits ranged from 8 to 14 mm. Following conduits were used: bovine jugular vein grafts (n = 23), porcine valved Dacron conduits (n = 19), other valved Xenografts (n = 11), and valveless Dacron or PTFE grafts (n = 14). We performed a Kaplan–Meier data review, starting at conduit implantation. Points of interest were intervention (cardiac catheter–based procedure), reoperation (operative conduit replacement), or death. Uni- and multivariate risk factor analyses for these endpoints were performed, using the Cox regression model. Data about pulmonary artery dimensions was collected by analyzing different preoperative imaging (CT scans, angiography, and echos) or intraoperative evaluation (vascular probes).
Result: We observed higher freedom from intervention of bovine jugular vein grafts, compared with porcine valved Dacron conduits (p = 0.020) and similar freedom from reoperation between all implanted conduits (p = 0.605). The following Table summarizes the results of univariate risk factor analysis for cardiac catheter–based reinterventions:
|
Risk/protective factor |
p-Value |
Hazard ratio (HR) |
CI 95% of HR |
|
Presence of MAPCAs |
0.006 |
2.803 ↗ |
1.337–5.875 |
|
Mc Goon ratio > 1.7 |
0.003 |
0.326 ↘ |
0.155–0.687 |
|
Nakata index > 170 mm2/m2 |
0.031 |
0.460 ↘ |
0.227–0.931 |
|
Porcine valved Dacron conduit |
0.015 |
2.344 ↗ |
1.184–4.641 |
|
Conduit size (Z score < 1) |
0.011 |
2.404 ↗ |
1.218–4.747 |
Conclusion: We conclude that absence of MAPCAs, an adequately developed pulmonary artery vascular system and moderate conduit oversizing (Z-score greater than +1) are diminishing the risk for early reintervention and conduit failure. All implanted small sized conduits show a similar behavior after surgery, although the porcine valved Dacron conduit seems to be more prone to cardiac catheter based reinterventions.
Publication History
Article published online:
19 February 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany