Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-10T06:18:08.821Z Has data issue: false hasContentIssue false
  • English
  • Français

Safe surgical strategy for extracardiac conduit replacement in common arterial trunk*

Published online by Cambridge University Press:  18 January 2013

Tom R. Karl
Tom R. Karl*
Affiliation:
Department of Cardiac Surgery, Queensland Paediatric Cardiac Service, Mater Children's Hospital, Brisbane, Australia
*
Correspondence to: Professor T. R. Karl, Queensland Paediatric Cardiac Service, Mater Children's Hospital, Raymond Terrace, Brisbane, QLD 4101, Australia. Tel: +61 736137597; E-mail: trkarl.aus@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Repair of common arterial trunk using an extracardiac right ventricular to pulmonary arterial conduit is the preferred method in most cardiac surgical centres. Reoperation is a fact of life for survivors of common arterial trunk and related cardiac lesions who have undergone such repairs. Long-term survivors may require periodic conduit revisions, with a potentially escalating technical difficulty and risk. Herein we present an analysis of the currently available choices for extracardiac conduits, and outline what we consider to be a safe and reliable surgical strategy for conduit revision.

Keywords

Truncusextracardiac conduitreoperation
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 6: A Lifelong Interdisciplinary Approach to Common Arterial Trunk, Transposition of the Great Arteries, and Other Evolving Challenges in Paediatric and Congenital Cardiac Disease , December 2012 , pp. 708 - 717
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Presented at the 12th International Symposium on Congenital Heart Disease (Truncus and Transposition), St. Petersburg, Florida, United States of America, February, 2012.

References

1. Sano, S, Karl, TR, Mee, RB. Extracardiac valved conduits in the pulmonary circuit. Ann Thorac Surg 1991; 52: 285–290.CrossRefGoogle ScholarPubMed
2. Sinzobahamvya, N, Boscheinen, M, Blaschczok, HC, et al. Survival and reintervention after neonatal repair of truncus arteriosus with valved conduit. Eur J Cardiothorac Surg 2008; 34: 732–737.Google Scholar
3. Askovich, B, Hawkins, JA, Sower, CT, et al. Right ventricle-to-pulmonary artery conduit longevity: is it related to allograft size? Ann Thorac Surg 2007; 84: 907–911; discussion 911-2.Google Scholar
4. Karamlou, T, Ungerleider, RM, Alsoufi, B, et al. Oversizing pulmonary homograft conduits does not significantly decrease allograft failure in children. Eur J Cardiothorac Surg 2005; 27: 548–553.Google Scholar
5. Mokhles, M, Rizopoulos, D, Andrinopoulou, ER, et al. Autograft and pulmonary allograft performance in the second post-operative decade after the Ross procedure: insights from the Rotterdam Prospective Cohort Study. Eur Heart J 2012; 33: 2213–2224.Google Scholar
6. O'Brien, MF, Harrocks, S, Stafford, EG, et al. The homograft aortic valve: a 29-year, 99.3% follow up of 1,022 valve replacements. J Heart Valve Dis 2001; 10: 334–344.Google Scholar
7. Homann, M, Haehnel, JC, Mendler, N, et al. Reconstruction of the RVOT with valved biological conduits: 25 years experience with allografts and xenografts. Eur J Cardiothorac Surg 2000; 17: 624–630.CrossRefGoogle ScholarPubMed
8. Michler, RE, Chen, JM, Quaegebeur, JM. Novel technique for extending the use of allografts in cardiac operations. Ann Thorac Surg 1994; 57: 83–87.CrossRefGoogle ScholarPubMed
9. Bramer, S, Mokhles, MM, Takkenberg, JJ, Bogers, AJ. Long-term outcome of right ventricular outflow tract reconstruction with bicuspidalized homografts. Eur J Cardiothorac Surg 2012; 40: 1392–1395.Google Scholar
10. Sfyridis, PG, Avramidis, DP, Kirvassilis, GV, Zavaropoulos, PN, Papagiannis, JK, Sarris, GE. The contegra® valved heterograft conduit for right ventricular outflow tract reconstruction: a reliable solution. J Cardiol 2011; 52: 501–508.Google Scholar
11. Urso, S, Rega, F, Meuris, B, et al. The Contegra conduit in the right ventricular outflow tract is an independent risk factor for graft replacement. Eur J Cardiothorac Surg 2011; 40: 603–609.Google ScholarPubMed
12. Christenson, JT, Sierra, J, Colina Manzano, NE, Jolou, J, Beghetti, M, Kalangos, A. Homografts and xenografts for right ventricular outflow tract reconstruction: long-term results. Ann Thorac Surg 2010; 90: 1287–1293.Google Scholar
13. Fiore, AC, Ruzmetov, M, Huynh, D, et al. Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age Contegra introduction. Eur J Cardiothorac Surg 2010; 38: 318–325.Google Scholar
14. Prior, N, Alphonso, N, Arnold, P, et al. Bovine jugular vein valved conduit: up to 10 years follow-up. J Thorac Cardiovasc Surg 2011; 141: 983–987.CrossRefGoogle ScholarPubMed
15. Hickey, EJ, McCrindle, BW, Blackstone, EH, et al. Jugular venous valved conduit (Contegra) matches allograft performance in infant truncus arteriosus repair. CHSS Pulmonary Conduit Working Group. Eur J Cardiothorac Surg 2008; 33: 890–898.Google Scholar
16. Lurz, P, Coats, L, Khambadkone, S, et al. Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome. Circulation 2008; 117: 1964–1972.Google Scholar
17. McElhinney, DB, Hellenbrand, WE, Zahn, EM, et al. Short- and medium-term outcomes after transcatheter pulmonary valve placement in the expanded multicenter US melody valve trial. Circulation 2010; 122: 507–516.Google Scholar
18. Hasan, BS, McElhinney, DB, Brown, DW, et al. Short-term performance of the transcatheter Melody valve in high-pressure hemodynamic environments in the pulmonary and systemic circulations. Circ Cardiovasc Interv 2011; 4: 615–620.CrossRefGoogle ScholarPubMed
19. Roberts, PA, Boudjemline, Y, Cheatham, JP, et al. Percutaneous tricuspid valve replacement in congenital and acquired heart disease. J Am Coll Cardiol 2011; 58: 117–122.Google Scholar
20. Quintessenza, JA, Jacobs, JP, Morell, VO, Giroud, JM, Boucek, RJ. Initial experience with a bicuspid polytetrafluoroethylene pulmonary valve in 41 children and adults: a new option for right ventricular outflow tract reconstruction. Ann Thorac Surg 2005; 79: 924–931.CrossRefGoogle ScholarPubMed
21. Schlichter, AJ, Kreutzer, C, Mayorquim, RC, et al. Five- to fifteen-year follow-up of fresh autologous pericardial valved conduits. J Thorac Cardiovasc Surg 2000; 119: 869–879.Google Scholar
22. Nunn, GR, Bennetts, J, Onikul, EJ. Durability of hand-sewn valves in the right ventricular outlet. J Thorac Cardiovasc Surg 2008; 136: 290–296.Google Scholar
23. Yoshida, M, Wearden, PD, Dur, O, Pekkan, K, Morell, VO. Right ventricular outflow tract reconstruction with bicuspid valved polytetrafluoroethylene conduit. Ann Thorac Surg 2011; 91: 1235–1238.CrossRefGoogle ScholarPubMed
24. Miyazaki, T, Yamagishi, M, Maeda, Y, et al. J Expanded polytetrafluoroethylene conduits and patches with bulging sinuses and fan-shaped valves in right ventricular outflow tract reconstruction: multicenter study in Japan. J Thorac Cardiovasc Surg 2011; 142: 1122–1129.Google Scholar
25. Haas, F, Schreiber, C, Hörer, J, Kostolny, M, Holper, K, Lange, R. Is there a role for mechanical valved conduits in the pulmonary position? Ann Thorac Surg 2005; 79: 1662–1667.Google Scholar
26. Waterbolk, TW, Hoendermis, ES, den Hamer, IJ, Ebels, T. Pulmonary valve replacement with a mechanical prosthesis. Promising results of 28 procedures in patients with congenital heart disease. Eur J Cardiothorac Surg 2006; 30: 28–32.Google Scholar
27. Ovcina, I, Knez, I, Curcic, P, et al. Pulmonary valve replacement with mechanical prostheses in re-do Fallot patients. Interact Cardiovasc Thorac Surg 2011; 12: 987–991; discussion 991-2.Google Scholar
28. Shin, HJ, Kim, YH, Ko, JK, Park, IS, Seo, DM. Outcomes of mechanical valves in the pulmonic position in patients with congenital heart disease over a 20-year period. Ann Thorac Surg 2012, [Epub ahead of print].Google Scholar
29. Perri, G, Polito, A, Esposito, C, et al. Early and late failure of tissue-engineered pulmonary valve conduits used for right ventricular outflow tract reconstruction in patients with congenital heart disease. Eur J Cardiothorac Surg 2012; 41: 1320–1325.Google Scholar
30. Yamanami, M, Yahata, Y, Uechi, M, et al. Development of a completely autologous valved conduit with the sinus of Valsalva using in-body tissue architecture technology: a pilot study in pulmonary valve replacement in a beagle model. Circulation 2010; 122 (11 Suppl.): S100–S106.Google Scholar
31. Dohmen, PM, Lembcke, A, Holinski, S, Pruss, A, Konertz, W. Ten years of clinical results with a tissue-engineered pulmonary valve. Ann Thorac Surg 2011; 92: 1308–1314.Google Scholar
32. Naito, Y, Imai, Y, Shin'oka, T, et al. Successful clinical application of tissue-engineered graft for extracardiac Fontan operation. J Thorac Cardiovasc Surg 2003; 125: 419–420.Google Scholar
33. Barbero-Marcial, M, Riso, A, Atik, E, Jatene, A. A technique for correction of truncus arteriosus types I and II without extracardiac conduits. J Thorac Cardiovasc Surg 1990; 99: 364–369.Google Scholar
34. Chiu, IS, Div, M, Huang, SC, et al. Surgical treatment of anomalies with discontinuity between the right ventricle and the pulmonary arteries without use of an extracardiac conduit. Ann Thorac Surg 2009; 87: 1220–1225.Google Scholar
35. Nakae, S, Kawada, M, Kasahara, S, Lin, ZB, Hiraishi, S, Yoshimura, H. Truncus arteriosus with interrupted aortic arch: successful correction using autologous flap. Ann Thorac Surg 1995; 60: 697–698.Google Scholar
36. R Cerfolio, RJ, Danielson, GK, Warnes, CA, et al. Results of an autologous tissue reconstruction for replacement of obstructed extracardiac conduits. J Thorac Cardiovasc Surg 1995; 110: 1359–1366.CrossRefGoogle Scholar
37. Raisky, O, Ali, WB, Bajolle, F, et al. Common arterial trunk repair: with conduit or without? Eur J Cardiothorac Surg 2009; 36: 675–682.Google Scholar
38. Chen, JM, Glickstein, JS, Davies, RR, et al. The effect of repair technique on postoperative right-sided obstruction in patients with truncus arteriosus. J Thorac Cardiovasc Surg 2005; 129: 559–568.CrossRefGoogle ScholarPubMed
39. Tirilomis, T, Friedrich, M, Zenker, D, Seipelt, RG, Schoendube, FA, Ruschewski, W. Indications for reoperation late after correction of tetralogy of Fallot. Cardiol Young 2010; 20: 396–401.CrossRefGoogle ScholarPubMed
40. Belli, E, Salihoğlu, E, Leobon, B, et al. The performance of Hancock porcine-valved Dacron conduit for right ventricular outflow tract reconstruction. Ann Thorac Surg 2010; 89: 152–157.CrossRefGoogle ScholarPubMed
41. Cassorla, L, Miller-Hance, WC, Rouine-Rapp, K, Reddy, VM, Hanley, FL, Silverman, NH. Reliability of intraoperative contrast transesophageal echocardiography for detecting interatrial communications in patients with other congenital cardiovascular malformations. Am J Cardiol 2003; 91: 1027–1031; A8-9.Google Scholar
42. Loebe, M, Alexi-Meskhishvili, V, Weng, Y, Hausdorf, G, Hetzer, R. Use of polytetrafluoroethylene surgical membrane as a pericardial substitute in the correction of congenital heart defects. Tex Heart Inst J 1993; 20: 213–217.Google Scholar
43. Sakuma, K, Iguchi, A, Ikada, Y, Tabayashi, K. Closure of the pericardium using synthetic bioabsorbable polymers. Ann Thorac Surg 2005; 80: 1835–1840.Google Scholar
44. Bel, A, Ricci, M, Piquet, J, et al. Prevention of postcardiopulmonary bypass pericardial adhesions by a new resorbable collagen membrane. Interact Cardiovasc Thorac Surg 2012; 14: 469–473.Google Scholar
45. Karl, TR, Iyer, KS, Sano, S, Mee, RB. Infant ECMO cannulation technique allowing preservation of carotid and jugular vessels. Ann Thorac Surg 1990; 50: 488–489.Google Scholar
46. Stark, J, Pacifico, AD. Reoperations in Cardiac Surgery. New York: Springer-Verlag, 1989.CrossRefGoogle Scholar
47. Bökenkamp, R, Blom, NA, De Wolf, D, Francois, K, Ottenkamp, J, Hazekamp, MG. Intraoperative stenting of pulmonary arteries. Eur J Cardiothorac Surg 2005; 27: 544–547.CrossRefGoogle ScholarPubMed
48. Menon, SC, Cetta, F, Dearani, JA, Burkhart, HA, Cabalka, AK, Hagler, DJ. Hybrid intraoperative pulmonary artery stent placement for congenital heart disease. Am J Cardiol 2008; 102: 1737–1741.Google Scholar