Association of Pulmonary Conduit Type and Size With Durability in Infants and Young Children

被引：85

作者：

Poynter, Jeffrey A. ^{[1
,17
]}

Eghtesady, Pirooz ^{[3
]}

McCrindle, Brian W. ^{[2
]}

Walters, Henry L., III ^{[4
]}

Kirshbom, Paul M. ^{[5
]}

Blackstone, Eugene H. ^{[6
]}

Husain, S. Adil ^{[7
]}

Overman, David M. ^{[8
]}

Austin, Erle H. ^{[9
]}

Karamlou, Tara ^{[10
]}

Lodge, Andrew J. ^{[11
]}

St Louis, James D. ^{[12
]}

Gruber, Peter J. ^{[13
]}

Ziemer, Gerhard ^{[14
]}

Davies, Ryan R. ^{[15
]}

Jacobs, Jeffrey P. ^{[16
]}

Brown, John W. ^{[17
]}

Williams, William G. ^{[1
]}

Tchervenkov, Christo I. ^{[18
]}

Jacobs, Marshall L. ^{[6
]}

Caldarone, Christopher A. ^{[1
]}

机构：

[1] Hosp Sick Children, Div Cardiac Surg, Toronto, ON M5G 1X8, Canada

[2] Hosp Sick Children, Div Pediat Cardiol, Toronto, ON M5G 1X8, Canada

[3] Washington Univ, Sect Pediat Cardiothorac Surg, St Louis, MO USA

[4] Childrens Hosp Michigan, Dept Cardiovasc Surg, Detroit, MI 48201 USA

[5] Yale Univ, Div Cardiac Surg, New Haven, CT USA

[6] Cleveland Clin, Dept Thorac & Cardiovasc Surg, Cleveland, OH 44106 USA

[7] Univ Texas Hlth Sci Ctr San Antonio, Div Cardiac Surg, San Antonio, TX 78229 USA

[8] Childrens Hosp & Clin Minnesota, Div Cardiovasc Surg, Minneapolis, MN USA

[9] Kosair Childrens Hosp, Div Cardiac Surg, Louisville, KY USA

[10] Univ Calif San Francisco, Div Cardiac Surg, San Francisco, CA 94143 USA

[11] Duke Univ, Div Cardiovasc Surg, Durham, NC USA

[12] Univ Minnesota, Div Cardiothorac Surg, Minneapolis, MN USA

[13] Primary Childrens Med Ctr, Div Cardiovasc Surg, Salt Lake City, UT 84103 USA

[14] Univ Chicago, Div Cardiac Surg, Chicago, IL 60637 USA

[15] Nemours AI DuPont Hosp Children, Div Cardiovasc Surg, Wilmington, DE USA

[16] Congenital Heart Inst Florida, Div Cardiac Surg, St Petersburg, FL USA

[17] Indiana Univ Sch Med, Div Cardiac Surg, Indianapolis, IN 46202 USA

[18] Montreal Childrens Hosp, Div Cardiovasc Surg, Montreal, PQ H3H 1P3, Canada

来源：

ANNALS OF THORACIC SURGERY | 2013年 / 96卷 / 05期

关键词：

VENTRICULAR OUTFLOW TRACT; JUGULAR-VEIN CONDUIT; CARDIAC-VALVE ALLOGRAFTS; CLASS-I; RECONSTRUCTION; IMPLANTATION; HOMOGRAFT; ANTIBODIES; EXPERIENCE; REPAIR;

D O I：

10.1016/j.athoracsur.2013.05.074

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background. Treatment of congenital heart disease may include placement of a right ventricle to pulmonary artery conduit that requires future surgical replacement. We sought to identify surgeon-modifiable factors associated with durability (defined as freedom from surgical replacement or explantation) of the initial conduit in children less than 2 years of age at initial insertion. Methods. Since 2002, 429 infants were discharged from 24 Congenital Heart Surgeons' Society member institutions after initial conduit insertion. Parametric hazard analysis identified factors associated with conduit durability while adjusting for patient characteristics, the institution where the conduit was inserted, and time-dependent interval procedures performed after conduit insertion but before replacement/explantation. Results. In all, 138 conduit replacements (32%) and 3 explantations (1%) were performed. Conduit durability at a median follow-up of 6.0 years (range, 0.1 to 11.7) was 63%. After adjusting for interval procedures and institution, placement of a conduit with smaller z-score was associated with earlier replacement/explantation (p = 0.002). Moreover, conduit durability was substantially reduced with aortic allografts (p = 0.002) and pulmonary allografts (p = 0.03) compared with bovine jugular venous valved conduits (JVVC). The JVVC were 12 mm to 22 mm in diameter at insertion (compared with 6 mm to 20 mm for allografts); therefore, a parametric propensity-adjusted analysis of patients with aortic or pulmonary allografts versus JVVC with diameter of 12 mm or greater was performed, which verified the superior durability of JVVC. Conclusions. Pulmonary conduit type and z-score are associated with late conduit durability independent of the effects of institution and subsequent interval procedures. Surgeons can improve long-term conduit durability by judiciously oversizing, and by selecting a JVVC. (C) 2013 by The Society of Thoracic Surgeons

引用

页码：1695 / 1702

页数：8

共 19 条

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