Abstract 10791: Improved Right Ventricular Outflow Tract Conduit Longevity using the Carpentier Edwards Porcine Valved Conduit
Background: The optimal conduit for right ventricular outflow tract (RVOT) reconstruction is uncertain, with varying degrees of longevity reported for pericardial, homograft and xenograft valves utilized in this position.
Methods: A retrospective review was conducted of children and adults with congenital heart disease that received RVOT reconstruction with the Carpentier Edwards™ (CE) porcine valved conduit from 2001–2009. Subject data was divided according to CE conduit size and all of the doppler derived trans-conduit gradients from postoperative echos were recorded.
Results: Two hundred thirty nine subjects received a CE conduit (ranging 12–30mm) for RVOT reconstruction. For 87% (208/239) this comprised at least a 2nd re-operation. Peri-operative mortality was 1.7% (4/239). Follow up data was available for 92% (216/235) of subjects. The increase in trans-conduit gradient over time was inversely proportional to the conduit size (see figure). For the entire series, freedom from re-operation was 65% at 8.2years. Freedom from re-operation for grouped conduit sizes is displayed (see figure).
Conclusions: In this series, the CE conduit showed slower progression of conduit stenosis as measured by RVOT gradient change than expected compared to previous reports. Patients that received 25 and 30mm conduits demonstrated a near zero to negative gradient change over time (slope: 0.04 ± 0.04 and −0.05 ± 0.04), a finding that is unusual and warrants further study. The re-operation rate for ≥ 16mm conduits was near zero suggesting that surgeons can confidently size match the conduit relative to the pulmonary artery bifurcation without the need for oversizing the graft.
- © 2010 by American Heart Association, Inc.