Long-term clinical and hemodynamic evaluation of porcine valved conduits implanted from the right ventricle to the pulmonary artery

被引:33
作者
Champsaur, G
Robin, J
Curtil, A
Tronc, F
Vedrinne, C
Sassolas, F
Bozio, A
Ninet, J
机构
[1] Hop Cardiol Louis Pradel, Dept Cardiovasc Surg, F-69003 Lyon, France
[2] Hop Cardiol Louis Pradel, Dept Pediat Cardiol, Lyon, France
[3] Hop Cardiol Louis Pradel, Dept Anesthesia & Postoperat Care, Lyon, France
[4] Univ Lyon 1, F-69365 Lyon, France
关键词
D O I
10.1016/S0022-5223(98)00443-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: This retrospective study was initiated to evaluate the long-term results of valved prosthetic conduits implanted in the right ventricular outflow tract in patients with complex ventricular-pulmonary discontinuity, Methods: A cohort of 103 patients out of 127 (24 early deaths, 19%) operated on between 1973 and 1996 with porcine valved conduits was available for evaluation, with a follow-up ranging from 1 to 21.6 years (mean follow-up 8.4 +/- 6 years). A total of 74 hemodynamic studies were performed after the operation, 50 patients having undergone at feast 1 cardiac catheterization during the follow-up period. Results: There were 16 late deaths, and the actuarial survivals, including early mortality, were 72.9% +/- 4% at 5 years, 63.1% +/- 5% at 10 years, and 58.2% +/- 5% at 15 years, at which time 20 patients were still available for review and exposed to the risk of dying. The mean peak systolic gradient across the right ventricular outflow tract was plotted as a function of time, showing a gradual increase and a significant step-up after the eighth year, from 43 +/- 36 to 69 +/- 19 mm Hg (P < .005), Reoperation was required for progressive conduit obstruction between 1.1 and 17.7 years after implantation (mean 7.4 +/- 4.8 years) in 25 patients (24%, 70% CL 15%-33%),,vith generally very few symptoms, or for residual ventricular septal defect in 3 patients. Freedom from reoperation was 79.5% +/- 5% at 10 years and 65.8% +/- 7% at 15 years. Conclusions: Porcine conduits may represent a valuable alternative to biologic substitutes with similar long-term results. Given the few symptoms, progressive Conduit stenosis after the eighth postoperative year imposes a yearly noninvasive patient evaluation during the follow-up.
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页码:793 / 803
页数:11
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