Valved Conduits and Conduit Exchange: Long-Term Follow-Up
Due to unsatisfactory long-term results with porcine valved conduits, the selection of material for extracardiac conduit surgery remains an unsolved problem. Between 1972 and 1987, 103 patients ranging from less than 1 year to 21 years of age underwent surgical repair of various types of complex congenital heart defects using an extracardiac valved conduit. The follow-up period ranged from 2 months to 10 years and included data of multiple catheterization and cross-sectional echocardiography. The probability of event-free conduit performance after 5 years was 80% and after 8 years was only 12%. Twenty-three conduits had to be replaced due to severe stenosis of the porcine valve. For the pericardial valved conduits, late results only up to 5 years are available. Four dysfunctions occurred (i.e., valvular stenosis and/or insufficiency) at 27 months (2 dysfunctions), 36, and 54 months after implantation. One death occurred during conduit exchange surgery. Since 1983 we have preferred to use antibiotic-preserved fresh aortic root homografts as conduit material in anticipation of better long-term results. However, the availability of homografts is limited, especially in the small sizes. In conclusion, the durability of porcine and bovine pericardial valved conduits in infants and children is limited. The early results with pericardial valved conduits in these patients is also limited. However, the early results with pericardial valved conduits are better than with comparable porcine valved conduits. The exchange of a malfunctioning conduit is a low-risk procedure. Therefore, the use of a valved conduit can be recommended for infants and small children whenever an aortic homograft is not suitable or available. Superior long-term results (i.e., more than 10 to 15 years) with aortic root homografts remain to be proven. The ideal conduit has not yet been found.
KeywordsVentricular Septal Defect Ventricular Septal Defect Pulmonary Atresia Dacron Graft Double Outlet Right Ventricle
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