Abstract 14276: Longevity and Factors Associated With Propensity to Failure in Subpulmonary Outflow Tract Conduit Reconstruction in Adult Patients With Congenital Heart Diseases
Background: Surgical placement of a subpulmonic ventricle to the pulmonary artery conduit is routinely utilized to treat various conotruncal congenital abnormalities. The main limitation of this procedure remains the need for reoperation due to conduit failure. Several predictors of shorter conduit longevity were identified in pediatric patients, yet it is uncertain whether these apply to adults. Our aims were therefore to evaluate the durability and identify parameters associated with conduit failure in adults.
Methods: 288 consecutive patients aged> 18 years with conduits sized≥ 18 mm were evaluated between 1/1991 and 12/2010 at our hospital. Predictor variables included demographic, clinical, imaging and procedure-related factors. The occurrence of conduit failure-related reintervention (due to stenosis, regurgitation or both) requiring surgical or percutaneous re-intervention served as our primary outcome.
Results: Median age at surgery was 19 years (range, 7-56), median follow up was 10.7 years (range, 1-36). The probabilities of freedom from primary outcome at 5 and 10 years were 89% and 62%, respectively. Mechanism of conduit failure was obstruction in 50% and combined with regurgitation in 37%. In a log-rank analysis evaluating age at surgery as a continuous variable, age≥ 22 was associated with lower probability of need for reintervention (35% vs. 63%, p=0.006). Younger age at surgery, active smoking, smaller conduit size and previous conduit placements were all independently associated with a need for reintervention in a multivariable model.
Conclusions: During long-term follow up, specific parameters associated with higher re-intervention rates were identified, some of them modifiable via patient education and utilization of different surgical techniques. As the numbers of adults with congenital heart diseases rise, this study provides more information on a common condition in this patient population.
- © 2013 by American Heart Association, Inc.