Surgery for right ventricle to pulmonary artery conduit obstruction: risk factors for further reoperation☆

Abstract

Our results support the optimal surgical approach for RV-PA conduit obstruction is total replacement with a xenograft. RV outflow reconstruction by other techniques without complete dissection of PA bifurcation does not completely relieve the stenosis and could cause early restenosis. Higher systolic gradients at discharge and younger age at first reoperation are predictors of earlier reoperation.

Disfunção do homoenxerto pulmonar utilizado na reconstrução do trato de saída do ventrículo direito

“…The option of this service for the use of the pulmonary homograft, in such position, is based on studies that show that the aortic homograft in pulmonary position presents higher index of calcification due to its composition rich in elastin [4][5][6][7][8][9][10][11][12][13][14][15] .…”

“…The small Z value of the pulmonary valva is also involved in the homograft dysfunction 7,8,20 . The higher dysfunction rate in our study was for a Z value below zero and above plus three, that is, the best results were obtained when the size of the pulmonary valva was between zero and plus three Z value.…”

“…The rate of homograft failure varies as per the study, being in 5 years between 10.0-40.0% 5,14 of the implanted homografts and, in 10 years, between 46.0-65.0% 4,7 .…”

“…From the surgical point of view, the pulmonary homograft is available in small sizes, has higher hemostatic capacity, higher ductility and handling easiness for the surgeon, their branches can be used for enlarging the stenotic areas in the pulmonary arteries, does not need chronic anticoagulation, presents higher resistance to endocarditis and has a potential feasibility for the second repair 5,7,10,11,[15][16][17][18] .…”

Adipose Derived Tissue Engineered Heart Valve

“…These valves can be either a mechanical, biological allogenic [6,7] or xenogenic [8] prosthesis. Unfortunately these replacements suffer from disadvantages associated with clinical limitations such as necessary lifelong anti-coagulation treatment, risk of immunogenic reactions or adverse reaction such as extensive calcification and degradation giving rise to possible reoperations [9,10]. Moreover, these prostheses lack the ability of both growth and remodeling.…”