Thorac Cardiovasc Surg 2014; 62 - OP56
DOI: 10.1055/s-0034-1367133

Size matters: Longevity of valved RVOT conduits is mainly related to the conduit diameter

J.S. Sachweh 1, A. Rueffer 2, J. Walk 1, D. Biermann 3, G. Mueller 4, H. Reichenspurner 3, A. Riso 1, R. Cesnjevar 2
  • 1Universitäres Herzzentrum Hamburg, Herzchirurgie für angeborene Herzfehler, Hamburg, Germany
  • 2Universitätsklinikum Erlangen, Kinderherzchirurgische Abteilung, Erlangen, Germany
  • 3Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Germany
  • 4Universitäres Herzzentrum Hamburg, Kinderkardiologie, Hamburg, Germany

Objectives: Reconstruction of the right ventricular outflow tract (RVOT) deemed necessary in many cardiac anomalies and is the most frequent surgical procedure in adults with congenital heart disease. RVOT reconstruction is often facilitated with a valved conduit; however, the type of conduit is still a matter of debate, as are the factors affecting its longevity.

Methods: Between 03/1997 and 12/2007 145 RVOT conduits (Contegra® n = 50, Homograft n = 38, Hancock® n = 36, Shelhigh® n = 18, Labcor® n = 2, Matrix® P n = 1) were implanted in 119 patients ((age 8.9 ± 10.1 years (4 days - 57 years); body weight 28.9 ± 24.4 kg (2.3 - 103 kg)). Patients with Labcor® and Matrix® conduits were excluded from further investigation due to small numbers. Follow-up of this retrospective study was obtained until 09/2013. Freedom from reoperation (n = 34) and intervention (Conduit dilatation or interventional valve replacement) (n = 10) was analysed with regard to type and diameter of the conduit; age, body surface area (BSA), Nakata-Index, and numbers of previous cardiac operations at time of conduit implantation.

Results: Follow-up was 5.9 ± 3.4 years (1 day - 15 years; 838 patient-years) and complete. Surgical mortality was 1.7% and late mortality 2.6% not related to conduit failure. Freedom from reoperation and intervention was 96.4, 85.4, 71.4, and 54.5% after 1, 4, 8, and 10 years with no significant difference for aortic and pulmonary homografts (p = 0.156). Univariate analysis revealed a longer freedom from reoperation and intervention for the Hancock® conduit in comparison to the Contegra® (p = 0.022) and Shelhigh® conduit (p = 0.031) and by trend in comparison to homografts® (p = 0.052). Freedom from reoperation and intervention was influenced by the diameter of the conduit (p = 0.001), and age (p = 0.07) and BSA (p = 0.08) at time of the operation; it was not affected by the preoperative Nakata index (p = 0.542) and the number of previous cardiac operations (p = 0.107). Multivariate regression analysis confirmed only diameter of the conduit as factor affecting freedom from reoperation and reintervention (p = 0.039)

Conclusion: In this large series, longevity of the valved conduits in the RVOT is influenced by the diameter of the valve substitute.