scholarly journals High Incidence Of Fever In Patients After BioIntegral Pulmonic Valved Conduit Implantation

2021 ◽  
Author(s):  
Arif Selcuk ◽  
Yiğit Kılıç ◽  
Oktay Korun ◽  
Okan Yurdakök ◽  
Murat Çiçek ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Length Of Hospital Stay ◽  
Right Ventricular Outflow Tract ◽  
Convincing Evidence ◽  
Adverse Outcomes ◽  
Short Term ◽  
Ross Operation ◽  
High Incidence ◽  
Valved Conduit

OBJECTIVE The aim of this study is to describe our short-term outcomes using BioIntegral pulmonic conduit. METHODS Between August 2018 and September 2019, the BioIntegral pulmonic valved conduit was used for right ventricular outflow tract reconstruction in 48 patients. The data was retrospectively retrieved from the patient charts. RESULTS The median age at the operation was 36 months (IQR:18-62 months). The diagnoses were PA-VSD in 28 patients, absent pulmonary valve in four patients, truncus arteriosus in six patients, TGA-VSD-PS in five patients, conduit stenosis in three patients and LVOT obstruction requiring Ross operation in two patients. In the postoperative follow-up 15 patients out of 48 had high fever. Out of these, 12 patients had concomitantly elevated CRP levels. There were no patients with blood culture positivity. The median postoperative length of hospital stay was 14 days (IQR:8-21 days). The overall mortality was recorded in 2 patients (4 %), one died due to right ventricular failure and multiple organ failure and one died due to pulmonary embolism. The two patients who died were not among the 15 patients with fever. CONCLUSIONS There was high incidence of fever and adverse outcomes in the short-term postoperative follow-up of the patients in whom the BioIntegral pulmonic valved conduit was implanted. Caution is advisable in using these conduits until there is convincing evidence about the sterilisation and storage standards of these grafts.

Autologous Pericardial Valved Conduit for the Ross Operation

2005 ◽  
Vol 13 (4) ◽  
pp. 321-324 ◽  
Author(s):  
Taweesak Chotivatanapong ◽  
Choosak Kasemsarn ◽  
Chaiwuth Yosthasurodom ◽  
Pradistchai Chaiseri ◽  
Vibhan Sungkahapong ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Artery Bypass ◽  
Pulmonary Regurgitation ◽  
Right Ventricular Outflow Tract ◽  
Functional Class ◽  
Valve Disease ◽  
Related Complication ◽  
Ross Operation ◽  
Valved Conduit

The feasibility and function of autologous pericardial valved conduit for right ventricular outflow tract reconstruction in the Ross operation were assessed. Between June 1997 and April 2002, 31 patients underwent this procedure at our institution; one was lost to follow-up. The other 26 males and 4 females were aged 17 to 60 years (mean, 36.6 years). Causes of aortic valve disease were infective endocarditis in 26 and rheumatic valve disease in 4. Mean follow-up was 16.7 months (range, 1–58 months). Preoperatively, 9 patients were in functional class II, 19 in class III, and 2 in class IV. Concomitant procedures included coronary artery bypass (1), mitral valve replacement (6), tricuspid valve replacement (1), and ventricular septal defect closure (1). Mean aortic crossclamp time was 199.4 min. There were 4 (13.3%) hospital deaths and no late death. Mean postoperative functional class was 1.17 with +0.36 aortic regurgitation, a peak gradient of 21.9 mm Hg (range, 6–59 mm Hg) across the conduit, and grade +0.96 pulmonary regurgitation. No conduit-related complication was detected. Use of autologous valved conduit for the Ross operation is feasible. Long-term follow-up is mandatory to assess durability.

scholarly journals Late Follow-Up of Rastelli Operation After One-Stage Repair with Right Ventricular Remodeling

2021 ◽  
pp. 1-4
Author(s):  
Miguel Maluf
Keyword(s):  
Coronary Artery ◽  
Right Ventricular ◽  
Ventricular Remodeling ◽  
Pulmonary Atresia ◽  
Right Ventricular Outflow Tract ◽  
Peripheral Oxygen Saturation ◽  
One Stage ◽  
Valved Conduit ◽  
The Right

We report long-term outcomes after one-stage, surgical repair, at an 11-year-old, girl with pulmonary atresia with a ventricular septal defect and anomalous origin of the left coronary artery from the right coronary artery, crossing the right ventricular outflow tract. The operation was carried out with the remodeling of the right ventricle, using a swine valved conduit prosthesis (22mm). Twenty-nine years later, the patient is in excellent clinical condition, CF I (NYHA), with normal peripheral oxygen saturation. Recent invasive and not invasive imaging show: the absence of intracardiac shunt, despite presenting prosthesis calcification and signs of mild double lesion of the prosthetic valve. The pulmonary flow is directed uniformly for both lungs. Patients undergoing the implantation of valved conduits during childhood, present mismatch, after a few years of follow-up, and are required to undergo frequent reoperations. In this patient, the indication of a Blalock-Taussig shunt, during childhood, allowed to postpone the surgery and implant a valved conduit with a larger diameter, achieving a long follow-up with a single prosthetic implant.

Sustained Improvement in Right Ventricular Chamber Dimensions 10 Years Following Xenograft Pulmonary Valve Replacement

2016 ◽  
Vol 8 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Heidi B. Schubmehl ◽  
Michael F. Swartz ◽  
Nader Atallah-Yunes ◽  
Carol Wittlieb-Weber ◽  
Rebecca E. Pratt ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Sustained Improvement ◽  
Z Scores ◽  
Valved Conduit ◽  
One Year ◽  
The Right

Background: The goals following pulmonary valve replacement (PVR) are to optimize right ventricular hemodynamics and minimize the need for subsequent reoperations on the right ventricular outflow tract. We hypothesized PVR using a xenograft valved conduit would result in superior freedom from reoperation with sustained improvement in right ventricular chamber dimensions. Methods: Xenograft valved conduits placed in patients aged >16 years were reviewed from 2000 to 2010 to allow for a 5-year minimum follow-up. Preoperative, one-year, and the most recent echocardiograms quantified right ventricular chamber dimensions, corresponding Z scores, and prosthetic valve function. Magnetic resonance imaging (MRI) studies compared preoperative and follow-up right ventricular volumes. Results: A total of 100 patients underwent PVR at 24 (19-34) years. Freedom from reintervention was 100% at 10 years. At most recent follow-up, only one patient had greater than mild pulmonary insufficiency. The one-year (17.3 ± 7.2 mm Hg; P < .01) and most recent follow-up (18.6 ± 9.8 mm Hg; P < .01) Doppler-derived right ventricular outflow tract gradients remained significantly lower than preoperative measurements (36.7 ± 27.0 mm Hg). Similarly, right ventricular basal diameter, basal longitudinal diameter, and the corresponding Z scores remained lower at one year and follow-up from preoperative measurements. From 34 MRI studies, the right ventricular end-diastolic indexed volume (161.7 ± 58.5 vs 102.9 ± 38.3; P < .01) and pulmonary regurgitant fraction (38.0% ± 15.9% vs 0.8% ± 3.3%; P < .01) were significantly lower at 7.1 ± 3.4 years compared to the preoperative levels. Conclusion: Use of a xenograft valved conduit for PVR results in excellent freedom from reoperation with sustained improvement in right ventricular dimensions at an intermediate-term follow-up.

Polytetrafluoroethylene Tricuspid Valved Conduit for Right Ventricular Outflow Tract Reconstruction

2021 ◽  
Author(s):  
Garrett N. Coyan ◽  
Luciana Da Fonseca Da Silva ◽  
Jose P. Da Silva ◽  
Melita Viegas ◽  
Victor O. Morell ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Valved Conduit

scholarly journals Right ventricular outflow tract stenting during neonatal and infancy periods: A multi-center, retrospective study

2020 ◽  
Vol 28 (3) ◽  
pp. 442-449
Author(s):  
İbrahim Cansaran İbrahim Cansaran Tanıdır
Keyword(s):  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Double Outlet Right Ventricle ◽  
Outflow Tract ◽  
Complex Congenital Heart Disease ◽  
Total Correction ◽  
Study Results ◽  
Correction Surgery

Background: The aim of this study was to evaluate the outcomes of right ventricular outflow tract stenting for palliation during the newborn and infancy periods. Methods: Between January 2013 and January 2018, a total of 38 patients (20 males, 18 females; median age 51 days; range, 3 days to 9 months) who underwent transcatheter right ventricular outflow tract stenting in three centers were retrospectively analyzed. Demographic characteristics, cardiac pathologies, angiographic procedural, and clinical follow-up data of the patients were recorded. Results: The diagnoses of the cases were tetralogy of Fallot (n=27), double outlet right ventricle (n=8), complex congenital heart disease (n=2), and Ebstein’s anomaly (n=1). The median weight at the time of stent implantation was 3.5 (range, 2 to 10) kg. Five cases had genetic abnormalities. The median pre-procedural oxygen saturation was 63% (range, 44 to 80%), and the median procedural time was 60 (range, 25 to 120) min. Acute procedural success ratio was 87%. Reintervention was needed in seven of patients due to stent narrowing during follow-up. During follow-up period, seven cases died. Total correction surgery was performed in 26 patients without any mortality. While a transannular patch was used in 22 patients, valve protective surgery was implemented in two patients, and the bidirectional Glenn procedure was performed in two patients. Conclusion: Based on our study results, right ventricular outflow tract stenting is a form of palliation which should be considered particularly in cases in whom total correction surgery is unable to be performed due to morbidity.

Abstract 4784: The Ross Operation: Lessons From Long Term Follow-up

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Laurent de Kerchove ◽  
Jean Rubay ◽  
Agnès Pasquet ◽  
Alain Poncelet ◽  
Munir Boodhwani ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Bleeding Event ◽  
Right Ventricular Outflow Tract ◽  
Aortic Insufficiency ◽  
Bleeding Events ◽  
Ross Operation ◽  
Increased Risk ◽  
Long Term Follow Up

Background: The Ross operation is considered the procedure of choice for aortic valve replacement in children and represents an attractive alternative in selected young adults. However, long term follow-up has demonstrated high rates of pulmonary autograft failure raising concern regarding its clinical utility. We analyze long term outcomes of our Ross series, focusing on predictors of autograft failure. Methods: Between 1991 and 2006, 260 consecutive patients underwent Ross operation. Mean age was 35±15 years (range: 1 day to 64 years) and 75% were male. The technique for autograft implantation was a full root replacement in 70% (n=183), inclusion cylinder in 28% (n=73) and subcoronary in 2% (n=4). Right ventricular outflow tract (RVOT) was reconstructed with a pulmonary homograft in 94% (n=245) and with a xenograft in 6% (n=15). Mean clinical follow-up (97% complete) was 97±46 months (13 to 196 months). Echocardiographic follow-up was available in 234 survivors (94%). Results: Hospital mortality was 1.9% (n=5) and 7 patients died during follow-up (3 non cardiac). Twelve year overall survival was 93±4% and freedom from autograft reoperation and from autograft valve replacement was 83±7% and 94±5% respectively. Twenty-five patients (9.6%) underwent autograft reoperation either for insufficiency (n=8), autograft or ascending aorta dilatation (n=6), or both (n=11) with no mortality. In 76% (n=19) of these patients, the autograft valve was preserved. Predictors for autograft dilatation (≥45 mm) were preoperative aortic insufficiency and full root technique. RVOT reintervention was required in 10 (4%) patients (reoperations n=7, balloon dilatation n=3). Twelve year freedom from RVOT reintervention was 95±4. Twelve year freedom from thrombo-embolic and bleeding events was 99±1% (1 stroke, 1 TIA, 1 bleeding event). Conclusions: This long terms study confirms the excellent survival after Ross operation with an extremely low rate of thrombo-embolic and bleeding events. Autograft reoperation rate remains acceptable. Full root technique is associated with increased risk of autograft dilatation, and should be avoided especially in adults with preoperative aortic insufficiency. Autograft valve preservation is feasible in autograft reoperation.

Contegra versus pulmonary homograft for right ventricular outflow tract reconstruction in newborns

2019 ◽  
Vol 29 (4) ◽  
pp. 505-510 ◽  
Author(s):  
Alessandro Falchetti ◽  
Hélène Demanet ◽  
Hugues Dessy ◽  
Christian Melot ◽  
Charalampos Pierrakos ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Heart Surgery ◽  
Multivariable Analysis ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Congenital Heart Surgery ◽  
Outflow Tract ◽  
Conflicting Evidence ◽  
Pulmonary Homograft

AbstractObjectives:Pulmonary homografts are standard alternatives to right ventricular outflow tract reconstruction in congenital heart surgery. Unfortunately, shortage and conduit failure by early calcifications and shrinking are observed for small-sized homografts in younger patients. In neonates, Contegra® 12 mm (Medtronic Inc., Minneapolis, Minnesota, United States of America) could be a valuable alternative, but conflicting evidence exists. There is no published study considering only newborns with heterogeneous pathologies. We retrospectively compared the outcomes of these two conduits in this challenging population.Methods:Patients who underwent a right ventricular outflow tract reconstruction between January 1992 and December 2014 at the Hôpital Universitaire des Enfants Reine Fabiola were included. We retrospectively collected and analysed demographic, echocardiographic, surgical, and follow-up data.Results:Of the 53 newborns who benefited from a right ventricular outflow tract reconstruction during the considered period, 30 received a Contegra 12 mm (mean age 15 ± 8 days), and 23 a small (9–14 mm) pulmonary homograft (mean age 10 ± 7 days). Overall mortality was 16.6% with Contegra versus 17.4% in the pulmonary homograft group (p = 0.98 log-rank). Operative morbidity and early re-operation for conduit failure were not significantly different between the two groups. Mean follow-up in this study is 121 ± 74 months. Survival free from re-operation was not different between the two groups (p = 0.15). Multivariable analysis showed that weight and significant early gradient were factors associated with anticipated conduit failure.Conclusions:Contegra 12 mm is a valid alternative to small pulmonary homografts in a newborn patient population. Trial registration: NCT03348397.

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