Subscribe to RSS
DOI: 10.1055/s-0035-1564930
A Novel Designed Valved Conduit for RVOT Reconstruction in Grown-up Congenital Heart Patients: a Glimpse Down the Road
Publication History
29 April 2015
31 August 2015
Publication Date:
16 October 2015 (online)
![](https://www.thieme-connect.de/media/thoracic/201601/lookinside/thumbnails/10-1055-s-0035-1564930_154141oc-1.jpg)
Abstract
Background A plethora of valves and valve conduits are available for reconstruction of the right ventricular outflow tract (RVOT) for grown-up congenital heart patients. However, for several reasons, the ideal pulmonary valve substitute still remains the subject of debate. In this study, we investigated the preliminary clinical and echocardiographic results after implantation of the RVOT Elan (Vascutek, Renfrewshire, United Kingdom) conduit in adolescents and adults.
Material and Methods Between October 2012 and December 2014, a total of 27 patients (19 males, mean age: 23.7 ± 22.5; range: 9–74 years) received a RVOT Elan conduit for RVOT reconstruction and were prospectively followed up clinically and echocardiographically. Twenty-five patients had previous cardiac surgery. The median number of prior operations per patient was 2 (range: 1–4). Tetralogy of Fallot was the most common diagnosis (n = 7).
Results At a mean follow-up time of 0.9 ± 0.61 years (100% complete), all patients (27 of 27) were alive and in New York Heart Association Class I. Adverse events defined as valve failure, thrombosis, embolism, bleeding, or endocarditis did not occur. Freedom from reoperation in general was 100%. At 1-year follow-up, median peak pressure gradients (Δ Pmax) across the RVOT Elan conduit were 15 ± 3.2; 15.3 ± 2.1Δ, 16 ± 4.8, and 16.3 ± 5.1 mm Hg for the 19 (n = 3), 21 (n = 3), 23 (n = 6), and 25 mm (n = 15) conduit size, respectively.
Conclusion The RVOT Elan conduit revealed excellent preliminary clinical and hemodynamic performances independent from the underlying cardiac pathology with insignificant transvalvular gradients and nonturbulent flow characteristics.
-
References
- 1 Yamamoto Y, Yamagishi M, Miyazaki T. Current status of right ventricular outflow tract reconstruction. Gen Thorac Cardiovasc Surg 2014; 67: 65-77
- 2 Lee C, Park CS, Lee CH , et al. Durability of bioprosthetic valves in the pulmonary position: long-term follow-up of 181 implants in patients with congenital heart disease. J Thorac Cardiovasc Surg 2011; 142 (2) 351-358
- 3 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 2013; 95 (4) 1367-1371
- 4 Weimar T, Roser D, Liebrich M, Horke A, Doll N, Hemmer WB. Strategies for biological heart valve replacement: stentless xenografts fail to evolve into an alternative pulmonary valve substitute in a Ross procedure. Biotechnol J 2013; 8 (3) 345-351
- 5 McClure RS, Narayanasamy N, Wiegerinck E , et al. Late outcomes for aortic valve replacement with the Carpentier-Edwards pericardial bioprosthesis: up to 17-year follow-up in 1,000 patients. Ann Thorac Surg 2010; 89 (5) 1410-1416
- 6 Mokhles MM, van de Woestijne PC, de Jong PL , et al. Clinical outcome and health-related quality of life after right-ventricular-outflow-tract reconstruction with an allograft conduit. Eur J Cardiothorac Surg 2011; 40 (3) 571-578
- 7 Rüffer A, Wittmann J, Potapov S , et al. Mid-term experience with the Hancock porcine-valved Dacron conduit for right ventricular outflow tract reconstruction. Eur J Cardiothorac Surg 2012; 42 (6) 988-995
- 8 Boethig D, Goerler H, Westhoff-Bleck M , et al. Evaluation of 188 consecutive homografts implanted in pulmonary position after 20 years. Eur J Cardiothorac Surg 2007; 32 (1) 133-142
- 9 Stark J, Bull C, Stajevic M, Jothi M, Elliott M, de Leval M. Fate of subpulmonary homograft conduits: determinants of late homograft failure. J Thorac Cardiovasc Surg 1998; 115 (3) 506-514 , discussion 514–516
- 10 Tweddell JS, Pelech AN, Frommelt PC , et al. Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation 2000; 102 (19) (Suppl. 03) III130-III135
- 11 Brown JW, Ruzmetov M, Rodefeld MD, Vijay P, Turrentine MW. Right ventricular outflow tract reconstruction with an allograft conduit in non-ross patients: risk factors for allograft dysfunction and failure. Ann Thorac Surg 2005; 80 (2) 655-663 , discussion 663–664
- 12 Ruzmetov M, Shah JJ, Geiss DM, Fortuna RS. Decellularized versus standard cryopreserved valve allografts for right ventricular outflow tract reconstruction: a single-institution comparison. J Thorac Cardiovasc Surg 2012; 143 (3) 543-549
- 13 Cebotari S, Lichtenberg A, Tudorache I , et al. Clinical application of tissue engineered human heart valves using autologous progenitor cells. Circulation 2006; 114 (1, Suppl): I132-I137
- 14 Jashari R, Van Hoeck B, Ngakam R, Goffin Y, Fan Y. Banking of cryopreserved arterial allografts in Europe: 20 years of operation in the European Homograft Bank (EHB) in Brussels. Cell Tissue Bank 2013; 14 (4) 589-599
- 15 Zilberman MV, Khoury PR, Kimball RT. Two-dimensional echocardiographic valve measurements in healthy children: gender-specific differences. Pediatr Cardiol 2005; 26 (4) 356-360
- 16 Chan KC, Fyfe DA, McKay CA, Sade RM, Crawford FA. Right ventricular outflow reconstruction with cryopreserved homografts in pediatric patients: intermediate-term follow-up with serial echocardiographic assessment. J Am Coll Cardiol 1994; 24 (2) 483-489
- 17 Akins CW, Miller DC, Turina MI , et al; STS; AATS; EACTS. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Ann Thorac Surg 2008; 85 (4) 1490-1495
- 18 Burchill LJ, Wald RM, Harris L, Colman JM, Silversides CK. Pulmonary valve replacement in adults with repaired tetralogy of Fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2011; 14 (1) 92-97
- 19 Swartz MF, Schiralli MP, Angona R, Cholette JM, Gensini F, Alfieris GM. The effect of repeat sternotomy during right ventricular outflow tract reconstruction. Congenit Heart Dis 2013; 8 (2) 142-148
- 20 Batlivala SP, Emani S, Mayer JE, McElhinney DB. Pulmonary valve replacement function in adolescents: a comparison of bioprosthetic valves and homograft conduits. Ann Thorac Surg 2012; 93 (6) 2007-2016
- 21 Rüffer A, Purbojo A, Cicha I , et al. Early failure of xenogenous de-cellularised pulmonary valve conduits—a word of caution!. Eur J Cardiothorac Surg 2010; 38 (1) 78-85
- 22 Hasan BS, Lunze FI, Chen MH , et al. Effects of transcatheter pulmonary valve replacement on the hemodynamic and ventricular response to exercise in patients with obstructed right ventricle-to-pulmonary artery conduits. JACC Cardiovasc Interv 2014; 7 (5) 530-542
- 23 Ross DN, Somerville J. Correction of pulmonary atresia with a homograft aortic valve. Lancet 1966; 2 (7479) 1446-1447
- 24 Meyns B, Jashari R, Gewillig M , et al. Factors influencing the survival of cryopreserved homografts. The second homograft performs as well as the first. Eur J Cardiothorac Surg 2005; 28 (2) 211-216 , discussion 216
- 25 Bowman Jr FO, Hancock WD, Malm JR. A valve-containing Dacron prosthesis. Its use in restoring pulmonary artery-right ventricular continuity. Arch Surg 1973; 107 (5) 724-728
- 26 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 (1) 152-157 , discussion 157–158
- 27 Raja SG. Contegra conduit: current outcomes and concerns. Expert Rev Cardiovasc Ther 2006; 4 (5) 721-730
- 28 Yang CC, Wei HJ, Hsieh SR , et al. Excellent mid-term durability of the On-X mechanical aortic valve in the pulmonary position with a low international normalized ratio. J Heart Valve Dis 2014; 23 (3) 333-337
- 29 Armstrong AK, Balzer DT, Cabalka AK , et al. One-year follow-up of the Melody transcatheter pulmonary valve multicenter post-approval study. JACC Cardiovasc Interv 2014; 7 (11) 1254-1262
- 30 Hartz RS, Deleon SY, Lane J , et al. Medtronic freestyle valves in right ventricular outflow tract reconstruction. Ann Thorac Surg 2003; 76 (6) 1896-1900
- 31 Erek E, Yalcinbas YK, Salihoglu E , et al. Fate of stentless bioprostheses on right side of the heart. Asian Cardiovasc Thorac Ann 2003; 11 (1) 58-62
- 32 Novick WM, Anic D, Lora Solf A , et al. Medtronic Freestyle valve for right ventricular reconstruction in pediatric Ross operations. Ann Thorac Surg 2004; 77 (5) 1711-1716
- 33 Tsukube T, Kawanishi Y, Murakami H , et al. Reconstruction of right ventricular outflow tract with stentless xenografts in Ross procedure. Artif Organs 2002; 26 (12) 1055-1059
- 34 Nozohoor S, Johansson S, Gustafsson R. Early surgical experience of right ventricular outflow reconstruction with the RVOT Elan conduit in adults and adolescents with congenital heart disease. Congenit Heart Dis 2014; 9 (6) 536-542