| Long-Term Follow-up
of Patients with Valvular and Non-valvular Extracardiac Conduits |
(Department of Cardiovascular Surgery, School of
Medicine, Keio University, Tokyo, Japan)
| Toshiyuki Katogi |
Ryo Aeba |
Katsumi Moro |
| Ichiro Kashima |
Kouji Tsutsumi |
Yoshimi Iino |
| Kenichi Hashizume |
Shigeyuki Takeuchi |
Shiaki Kawada |
|
Here we present a long-term follow-up
of 50 operative survivors, who underwent surgery between December
1975 and March 1994 for the placement of an extracardiac conduit.
Twenty-six patients received conduits with various valves (VC
group). The valves used were the Hancock valve in 9 patients,
the St. Jude Medical valve in 5, and a valved roll made of equine
pericardium in 10. Twenty-four patients received valveless Dacron
conduits (NVC group). Another group of patients, also with discontinuity
between the right ventricle and the pulmonary artery, who were
operated on without the use of a conduit, is presented here for
comparison (NCR group: 16 patients). The follow-up period for
the NCR group was shorter than for the other groups. There were
a total of 4 late deaths in the conduit groups, and none in the
NCR group. Freedom from reoperation due to conduit stenosis was
analyzed by the Kaplan-Meier method. In the VC group, freedom
from reoperation at 5, 10, and 15 years, was 87.8%, 50.8%, and
31.2% respectively. In the NVC group, freedom from reoperation
at 5,10，and15 years was 100%, 95.7%, and 60.4%. There were statistically
significant differences between the values in these 2 groups.
In the NCR group, only one patient (6.25%) underwent reoperation
due to stenosis in the right ventricular outflow tract. Although
the rate of freedom from reoperation was lower in the valveless
conduit group than in the valved conduit group, the majority
of patients who receive a conduit between the right ventricle
and the pulmonary artery will eventually require reoperation.
Avoiding the use of an extracardiac conduit, and creating continuity
between the right ventricle and pulmonary artery with autologous
tissue is a useful alternative and may reduce the need for reoperation.
Jpn. J. Cardiovasc. Surg. 29: 79-82 (2000) |
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