Reoperative right ventricular outflow tract conduit reconstruction: Risk analyses at follow up

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background and aim of the study: Right ventricular-to-pulmonary artery (RV-PA) conduits are implanted in the right ventricular outflow tract (RVOT) of children, with the knowledge that future reoperation will likely be required. The authors' experience of conduit RVOT reconstruction was reviewed in order to assess the frequency of conduit replacement and to determine risk factors for conduit dysfunction and failure. Methods: Between January 1980 and April 2007, a total of 261 patients (mean age 8.7 ± 11.7 years) underwent primary RVOT reconstruction with an RV-PA conduit at the authors' institution. There were 19 (7%) early deaths. Among the survivors, 84 (35%) underwent conduit expiant at the implanting hospital with insertion of a second conduit at a mean of 6.0 ± 3.7 years (range: 7 months to 22 years) after the first implantation. The primary operation and reoperation patient groups were compared with regard to the incidence of early death, late death, conduit-related intervention without expiant, and conduit explant. Results: Six risk factors for mortality were significant on univariate analyses: surgery before 1992 (p = 0.005), age <3 months (p = 0.001), diagnosis of truncus arteriosus (p <0.001), reconstruction with allografts (p = 0.05), association with interrupted aortic arch (p = 0.05) and with truncal valve insufficiency (p = 0.05). Of these six factors, only the diagnosis of truncus arteriosus (p = 0.001) and surgery before 1992 (p = 0.05) remained significant by multivariate analysis. Univariable analysis was performed for multiple factors, of which the following were found to be significant: body weight (p <0.003), age (p = 0.002), conduit diameter (p <0.0001), conduit type (p = 0.006), and diagnosis of truncus arteriosus (p <0.0001). Multivariable analysis of significant univariable risks revealed small allograft diameter (p <0.001) and diagnosis of truncus arteriosus (p <0.001) to be significant risk-factors for need of replacement. Conclusion: Most RVOT conduits placed in children will eventually require replacement. Patient survival for conduit replacement is comparable to that for primary conduit placement. Reoperative conduit RVOT reconstruction is possible, with low morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)119-126
Number of pages8
JournalJournal of Heart Valve Disease
Volume17
Issue number1
StatePublished - Jan 1 2008

Fingerprint

Truncus Arteriosus
Reoperation
Pulmonary Artery
Allografts
Mortality
Thoracic Aorta
Survivors
Multivariate Analysis
Body Weight
Morbidity
Survival
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{fc57e6c1632f48119d9acc0e11a47ce7,
title = "Reoperative right ventricular outflow tract conduit reconstruction: Risk analyses at follow up",
abstract = "Background and aim of the study: Right ventricular-to-pulmonary artery (RV-PA) conduits are implanted in the right ventricular outflow tract (RVOT) of children, with the knowledge that future reoperation will likely be required. The authors' experience of conduit RVOT reconstruction was reviewed in order to assess the frequency of conduit replacement and to determine risk factors for conduit dysfunction and failure. Methods: Between January 1980 and April 2007, a total of 261 patients (mean age 8.7 ± 11.7 years) underwent primary RVOT reconstruction with an RV-PA conduit at the authors' institution. There were 19 (7{\%}) early deaths. Among the survivors, 84 (35{\%}) underwent conduit expiant at the implanting hospital with insertion of a second conduit at a mean of 6.0 ± 3.7 years (range: 7 months to 22 years) after the first implantation. The primary operation and reoperation patient groups were compared with regard to the incidence of early death, late death, conduit-related intervention without expiant, and conduit explant. Results: Six risk factors for mortality were significant on univariate analyses: surgery before 1992 (p = 0.005), age <3 months (p = 0.001), diagnosis of truncus arteriosus (p <0.001), reconstruction with allografts (p = 0.05), association with interrupted aortic arch (p = 0.05) and with truncal valve insufficiency (p = 0.05). Of these six factors, only the diagnosis of truncus arteriosus (p = 0.001) and surgery before 1992 (p = 0.05) remained significant by multivariate analysis. Univariable analysis was performed for multiple factors, of which the following were found to be significant: body weight (p <0.003), age (p = 0.002), conduit diameter (p <0.0001), conduit type (p = 0.006), and diagnosis of truncus arteriosus (p <0.0001). Multivariable analysis of significant univariable risks revealed small allograft diameter (p <0.001) and diagnosis of truncus arteriosus (p <0.001) to be significant risk-factors for need of replacement. Conclusion: Most RVOT conduits placed in children will eventually require replacement. Patient survival for conduit replacement is comparable to that for primary conduit placement. Reoperative conduit RVOT reconstruction is possible, with low morbidity and mortality.",
author = "Rodefeld, {Mark D.} and Mark Ruzmetov and Turrentine, {Mark W.} and Brown, {John W.}",
year = "2008",
month = "1",
day = "1",
language = "English (US)",
volume = "17",
pages = "119--126",
journal = "Journal of Heart Valve Disease",
issn = "0966-8519",
publisher = "ICR Publishers Ltd",
number = "1",

}

TY - JOUR

T1 - Reoperative right ventricular outflow tract conduit reconstruction

T2 - Risk analyses at follow up

AU - Rodefeld, Mark D.

AU - Ruzmetov, Mark

AU - Turrentine, Mark W.

AU - Brown, John W.

PY - 2008/1/1

Y1 - 2008/1/1

N2 - Background and aim of the study: Right ventricular-to-pulmonary artery (RV-PA) conduits are implanted in the right ventricular outflow tract (RVOT) of children, with the knowledge that future reoperation will likely be required. The authors' experience of conduit RVOT reconstruction was reviewed in order to assess the frequency of conduit replacement and to determine risk factors for conduit dysfunction and failure. Methods: Between January 1980 and April 2007, a total of 261 patients (mean age 8.7 ± 11.7 years) underwent primary RVOT reconstruction with an RV-PA conduit at the authors' institution. There were 19 (7%) early deaths. Among the survivors, 84 (35%) underwent conduit expiant at the implanting hospital with insertion of a second conduit at a mean of 6.0 ± 3.7 years (range: 7 months to 22 years) after the first implantation. The primary operation and reoperation patient groups were compared with regard to the incidence of early death, late death, conduit-related intervention without expiant, and conduit explant. Results: Six risk factors for mortality were significant on univariate analyses: surgery before 1992 (p = 0.005), age <3 months (p = 0.001), diagnosis of truncus arteriosus (p <0.001), reconstruction with allografts (p = 0.05), association with interrupted aortic arch (p = 0.05) and with truncal valve insufficiency (p = 0.05). Of these six factors, only the diagnosis of truncus arteriosus (p = 0.001) and surgery before 1992 (p = 0.05) remained significant by multivariate analysis. Univariable analysis was performed for multiple factors, of which the following were found to be significant: body weight (p <0.003), age (p = 0.002), conduit diameter (p <0.0001), conduit type (p = 0.006), and diagnosis of truncus arteriosus (p <0.0001). Multivariable analysis of significant univariable risks revealed small allograft diameter (p <0.001) and diagnosis of truncus arteriosus (p <0.001) to be significant risk-factors for need of replacement. Conclusion: Most RVOT conduits placed in children will eventually require replacement. Patient survival for conduit replacement is comparable to that for primary conduit placement. Reoperative conduit RVOT reconstruction is possible, with low morbidity and mortality.

AB - Background and aim of the study: Right ventricular-to-pulmonary artery (RV-PA) conduits are implanted in the right ventricular outflow tract (RVOT) of children, with the knowledge that future reoperation will likely be required. The authors' experience of conduit RVOT reconstruction was reviewed in order to assess the frequency of conduit replacement and to determine risk factors for conduit dysfunction and failure. Methods: Between January 1980 and April 2007, a total of 261 patients (mean age 8.7 ± 11.7 years) underwent primary RVOT reconstruction with an RV-PA conduit at the authors' institution. There were 19 (7%) early deaths. Among the survivors, 84 (35%) underwent conduit expiant at the implanting hospital with insertion of a second conduit at a mean of 6.0 ± 3.7 years (range: 7 months to 22 years) after the first implantation. The primary operation and reoperation patient groups were compared with regard to the incidence of early death, late death, conduit-related intervention without expiant, and conduit explant. Results: Six risk factors for mortality were significant on univariate analyses: surgery before 1992 (p = 0.005), age <3 months (p = 0.001), diagnosis of truncus arteriosus (p <0.001), reconstruction with allografts (p = 0.05), association with interrupted aortic arch (p = 0.05) and with truncal valve insufficiency (p = 0.05). Of these six factors, only the diagnosis of truncus arteriosus (p = 0.001) and surgery before 1992 (p = 0.05) remained significant by multivariate analysis. Univariable analysis was performed for multiple factors, of which the following were found to be significant: body weight (p <0.003), age (p = 0.002), conduit diameter (p <0.0001), conduit type (p = 0.006), and diagnosis of truncus arteriosus (p <0.0001). Multivariable analysis of significant univariable risks revealed small allograft diameter (p <0.001) and diagnosis of truncus arteriosus (p <0.001) to be significant risk-factors for need of replacement. Conclusion: Most RVOT conduits placed in children will eventually require replacement. Patient survival for conduit replacement is comparable to that for primary conduit placement. Reoperative conduit RVOT reconstruction is possible, with low morbidity and mortality.

UR - http://www.scopus.com/inward/record.url?scp=43749116441&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=43749116441&partnerID=8YFLogxK

M3 - Article

C2 - 18365579

AN - SCOPUS:43749116441

VL - 17

SP - 119

EP - 126

JO - Journal of Heart Valve Disease

JF - Journal of Heart Valve Disease

SN - 0966-8519

IS - 1

ER -