REPAIR OF CONOTRUNCAL ABNORMALITIES WITH THE USE OF THE VALVED CONDUIT - IMPROVED EARLY AND MIDTERM RESULTS WITH THE CRYOPRESERVED HOMOGRAFT

Repair of complex cardiac lesions has been facilitated by the availability of valved conduits to reestablish right ventricular to pulmonary artery continuity. From 1977 to June 1991, 148 patients underwent repair with insertion of a conduit. Their mean age was 6.6 years (11 days to 45 years). The diagnosis was transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction in 51, truncus arteriosus in 36, pulmonary atresia with ventricular septal defect in 25, tetralogy of Fallot in 19, double-outlet right ventricle in 10, pulmonary atresia with intact ventricular septum in 6 and atrioventricular canal with pulmonary atresia in 1. A Dacron porcine-valved conduit was used in 37, a homograft conduit in 106 and a nonvalved conduit in 5. There were 13 early deaths overall (8.8 %); 8 (22 %) of the early deaths occurred in the 37 patients who received a Dacron graft, 4 (3.8 %) occurred in the 106 patients who received a homograft and 1 occurred in a patient with a nonvalved Gore-Tex conduit. An additional patient underwent orthotopic heart transplantation in the early postoperative period. In 117 patients operated on from January 1985 to June 1991 the early mortality rate was 2.6 % (3 of 117). Among 28 patients receiving a Dacron porcine-valved graft there were two late deaths (7.1 %) after a mean follow-up interval of 93 months, and 8 patients required reoperation for conduit obstruction. Among 102 homograft recipients there were two late deaths (1.9 %). Six homografts (5.9 %) have required replacement for stenosis during a mean follow-up interval of 50 months. The use of a cryopreserved homograft has been associated with a reduced early mortality and excellent early and midterm results for repair of conotruncal abnormalities.