Long-term course after pediatric right ventricular outflow tract reconstruction

Long-term course after pediatric right ventricular outflow tract reconstruction

Objectives Valved homografts are commonly used for right ventricular outflow tract reconstruction. However, despite good early results, they lack durability. This study was designed to compare single-center results of implantation of 3 types of right ventricular outflow tract conduit, in terms of pa...

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Veröffentlicht in:Asian cardiovascular & thoracic annals 2021-07, Vol.29 (6), p.483-489
Hauptverfasser: Junnil, Pimchanok, Cheanvechai, Chalit, Namchaisiri, Jule, Saprungruang, Ankavipar, Thitivaraporn, Puwadon, Chomvilailuk, Mueanthep, Benjacholamas, Vichai
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container_issue 6
container_start_page 483
container_title Asian cardiovascular & thoracic annals
container_volume 29
creator Junnil, Pimchanok
Cheanvechai, Chalit
Namchaisiri, Jule
Saprungruang, Ankavipar
Thitivaraporn, Puwadon
Chomvilailuk, Mueanthep
Benjacholamas, Vichai
description Objectives Valved homografts are commonly used for right ventricular outflow tract reconstruction. However, despite good early results, they lack durability. This study was designed to compare single-center results of implantation of 3 types of right ventricular outflow tract conduit, in terms of patient survival, graft failure, reoperation, and risk factors for reoperation. Methods One hundred and forty-three pediatric patients who underwent right ventricular outflow tract conduit implantation between January 2006 and December 2018 were reviewed. We stratified conduits by aortic, pulmonic homograft, and Contegra; 74 aortic homografts, 61 pulmonic homografts, and 8 Contegra conduits were implanted. Median age at implantation was 3 years. The primary diagnosis was truncus arteriosus in 41.3%. We analyzed the role of sex, age, diagnosis, and graft size. Endpoints included freedom from graft failure, freedom from reoperation, and survival. Results The survival rate was 83.2% at 10 years. Freedom from graft failure at 2, 5, and 10 years was 100%, 97.9%, and 63.4%, respectively. Freedom from reoperation was 85.8% for pulmonic homografts and 74.9% for aortic homografts at 10 years, and 100% for Contegra at 6 years. Multivariable analysis identified conduit diameter
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However, despite good early results, they lack durability. This study was designed to compare single-center results of implantation of 3 types of right ventricular outflow tract conduit, in terms of patient survival, graft failure, reoperation, and risk factors for reoperation. Methods One hundred and forty-three pediatric patients who underwent right ventricular outflow tract conduit implantation between January 2006 and December 2018 were reviewed. We stratified conduits by aortic, pulmonic homograft, and Contegra; 74 aortic homografts, 61 pulmonic homografts, and 8 Contegra conduits were implanted. Median age at implantation was 3 years. The primary diagnosis was truncus arteriosus in 41.3%. We analyzed the role of sex, age, diagnosis, and graft size. Endpoints included freedom from graft failure, freedom from reoperation, and survival. Results The survival rate was 83.2% at 10 years. Freedom from graft failure at 2, 5, and 10 years was 100%, 97.9%, and 63.4%, respectively. Freedom from reoperation was 85.8% for pulmonic homografts and 74.9% for aortic homografts at 10 years, and 100% for Contegra at 6 years. Multivariable analysis identified conduit diameter &lt;18 mm as a risk factor for reoperation (hazard ratio: 3.16, 95% confidence interval: 1.38–7.23, p = 0.007). Conclusion Homograft valves used for right ventricular outflow tract reconstruction provided excellent long-term durability and late survival. The only factor that adversely affected graft longevity was small graft size (diameter &lt;18 mm). Reoperation for conduit failure was not significantly different among the groups.</description><identifier>ISSN: 0218-4923</identifier><identifier>EISSN: 1816-5370</identifier><identifier>DOI: 10.1177/0218492320983449</identifier><identifier>PMID: 33334127</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><ispartof>Asian cardiovascular &amp; thoracic annals, 2021-07, Vol.29 (6), p.483-489</ispartof><rights>The Author(s) 2020</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-cd868a908d5138144763e84f3e6f1dc2415a13f701c36f7ad625e7151cbe21e43</citedby><cites>FETCH-LOGICAL-c337t-cd868a908d5138144763e84f3e6f1dc2415a13f701c36f7ad625e7151cbe21e43</cites><orcidid>0000-0001-7409-5741 ; 0000-0002-5455-5963</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0218492320983449$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0218492320983449$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21817,27922,27923,43619,43620</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33334127$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Junnil, Pimchanok</creatorcontrib><creatorcontrib>Cheanvechai, Chalit</creatorcontrib><creatorcontrib>Namchaisiri, Jule</creatorcontrib><creatorcontrib>Saprungruang, Ankavipar</creatorcontrib><creatorcontrib>Thitivaraporn, Puwadon</creatorcontrib><creatorcontrib>Chomvilailuk, Mueanthep</creatorcontrib><creatorcontrib>Benjacholamas, Vichai</creatorcontrib><title>Long-term course after pediatric right ventricular outflow tract reconstruction</title><title>Asian cardiovascular &amp; thoracic annals</title><addtitle>Asian Cardiovasc Thorac Ann</addtitle><description>Objectives Valved homografts are commonly used for right ventricular outflow tract reconstruction. However, despite good early results, they lack durability. This study was designed to compare single-center results of implantation of 3 types of right ventricular outflow tract conduit, in terms of patient survival, graft failure, reoperation, and risk factors for reoperation. Methods One hundred and forty-three pediatric patients who underwent right ventricular outflow tract conduit implantation between January 2006 and December 2018 were reviewed. We stratified conduits by aortic, pulmonic homograft, and Contegra; 74 aortic homografts, 61 pulmonic homografts, and 8 Contegra conduits were implanted. Median age at implantation was 3 years. The primary diagnosis was truncus arteriosus in 41.3%. We analyzed the role of sex, age, diagnosis, and graft size. Endpoints included freedom from graft failure, freedom from reoperation, and survival. Results The survival rate was 83.2% at 10 years. Freedom from graft failure at 2, 5, and 10 years was 100%, 97.9%, and 63.4%, respectively. Freedom from reoperation was 85.8% for pulmonic homografts and 74.9% for aortic homografts at 10 years, and 100% for Contegra at 6 years. Multivariable analysis identified conduit diameter &lt;18 mm as a risk factor for reoperation (hazard ratio: 3.16, 95% confidence interval: 1.38–7.23, p = 0.007). Conclusion Homograft valves used for right ventricular outflow tract reconstruction provided excellent long-term durability and late survival. The only factor that adversely affected graft longevity was small graft size (diameter &lt;18 mm). 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However, despite good early results, they lack durability. This study was designed to compare single-center results of implantation of 3 types of right ventricular outflow tract conduit, in terms of patient survival, graft failure, reoperation, and risk factors for reoperation. Methods One hundred and forty-three pediatric patients who underwent right ventricular outflow tract conduit implantation between January 2006 and December 2018 were reviewed. We stratified conduits by aortic, pulmonic homograft, and Contegra; 74 aortic homografts, 61 pulmonic homografts, and 8 Contegra conduits were implanted. Median age at implantation was 3 years. The primary diagnosis was truncus arteriosus in 41.3%. We analyzed the role of sex, age, diagnosis, and graft size. Endpoints included freedom from graft failure, freedom from reoperation, and survival. Results The survival rate was 83.2% at 10 years. Freedom from graft failure at 2, 5, and 10 years was 100%, 97.9%, and 63.4%, respectively. Freedom from reoperation was 85.8% for pulmonic homografts and 74.9% for aortic homografts at 10 years, and 100% for Contegra at 6 years. Multivariable analysis identified conduit diameter &lt;18 mm as a risk factor for reoperation (hazard ratio: 3.16, 95% confidence interval: 1.38–7.23, p = 0.007). Conclusion Homograft valves used for right ventricular outflow tract reconstruction provided excellent long-term durability and late survival. The only factor that adversely affected graft longevity was small graft size (diameter &lt;18 mm). Reoperation for conduit failure was not significantly different among the groups.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>33334127</pmid><doi>10.1177/0218492320983449</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-7409-5741</orcidid><orcidid>https://orcid.org/0000-0002-5455-5963</orcidid></addata></record>
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