1
|
Yue C, Li J, Zhang J, Wang Q, Wang X. Association between postoperative exposure to fine particulate matter and patency of the right ventricle-pulmonary artery conduit. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166604. [PMID: 37634733 DOI: 10.1016/j.scitotenv.2023.166604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/30/2023] [Accepted: 08/25/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Ambient air pollution is a leading risk factor for cardiovascular diseases. No study has investigated the association between exposure to fine particulate matter <2.5 μm in aerodynamic diameter (PM2.5) and the prognosis of patients undergoing surgery for the right ventricle-pulmonary artery (RV-PA) conduit. METHODS From 2013 to 2020, patients with six complicated congenital heart defects who had undergone surgery for the RV-PA conduit were selected. Four conduit materials were used: bovine jugular vein graft (BJV), pulmonary homograft (PHG), aortic homograft (AHG), and handmade tri-leaflet expanded polytetrafluoroethylene (ePTFE) conduit. Telephone interviews were used to confirm the postoperative address of patients. The monthly average PM2.5 concentration was obtained from the ChinaHighPM2.5 dataset using the place of residence of patients. By comparing findings of echocardiography undertaken before patients' return to their residence and during re-examination, we defined an increase in the trans-conduit peak velocity of ≥1.5 m/s as the study endpoint. RESULTS We enrolled 232 patients. Compared with BJV conduits, homografts (AHGs and PHGs) (0.052 (95 % CI = 0.005-0.558), P = 0.015) and ePTFE conduits (0.009 (95 % CI = 0.002-0.054), P < 0.001) were protective factors. The cumulative monthly PM2.5 concentration (10 μg/m3) was a risk factor (1.014 (95 % CI = 1.001-1.026), P = 0.028). Winter experience was a risk factor (1.971 (95 % CI: 1.021-3.804), P = 0.043). In the subgroup analysis, Spearman correlation analysis indicated BJV conduits (r = 0.680, P < 0.001), PHGs (r = 0.559, P = 0.020), and AHGs (r = 0.745, P = 0.021) had medium-to-high positive correlations between the cumulative PM2.5 concentration and change in the conduit velocity. For ePTFE, the correlation was weak and not significant (r = 0.222, P = 0.073). CONCLUSIONS Postoperative exposure to PM2.5 affects the patency of biologic prosthetic conduits (especially xenografts). The increase in the velocity of the ePTFE conduit is not associated with PM2.5 exposure, and is a suitable material for patients living in areas with high pollutant concentrations.
Collapse
Affiliation(s)
- Chao Yue
- Department of Pediatric Cardiac Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China
| | - Jin Li
- State Key Joint Laboratory of Environment Simulation and Pollution Control, School of Environment, Tsinghua University, No.30 Shuangqing Street, Haidian District, Beijing 100084, China
| | - Jiaqi Zhang
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China
| | - Qiang Wang
- Department of Pediatric Cardiac Center, Anzhen Hospital, Capital Medical University, No.2 Anzhen Street, Chaoyang District, Beijing 100029, China
| | - Xu Wang
- Department of Pediatric Cardiac Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing 100037, China.
| |
Collapse
|
2
|
Nichay NR, Dokuchaeva AA, Kulyabin YY, Boyarkin EV, Kuznetsova EV, Rusakova YL, Murashov IS, Vaver AA, Bogachev-Prokophiev AV, Zhuravleva IY. Epoxy- versus Glutaraldehyde-Treated Bovine Jugular Vein Conduit for Pulmonary Valve Replacement: A Comparison of Morphological Changes in a Pig Model. Biomedicines 2023; 11:3101. [PMID: 38002101 PMCID: PMC10669752 DOI: 10.3390/biomedicines11113101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
Valved conduits are often required to replace pulmonary arteries (PA). A widely used Contegra device is made of bovine jugular vein (BJV), preserved with glutaraldehyde (GA) and iso-propanol. However, it has several drawbacks that may be attributed to its chemical treatment. We hypothesized that the use of an alternative preservation compound may significantly improve BJV conduit performance. This study aimed to compare the macroscopic and microscopic properties of the BJV treated with diepoxide (DE) and GA in a porcine model. Twelve DE-BJVs and four Contegra conduits were used for PA replacement in minipigs. To assess the isolated influence of GA, we included an additional control group-BJV treated with 0.625% GA (n = 4). The animals were withdrawn after 6 months of follow-up and the conduits were examined. Explanted DE-BJV had a soft elastic wall with no signs of thrombosis or calcification and good conduit integration, including myofibroblast germination, an ingrowth of soft connective tissue formations and remarkable neoangiogenesis. The inner surface of DE-BJVs was covered by a thin neointimal layer with a solid endothelium. Contegra grafts had a stiffer wall with thrombosis on the leaflets. Calcified foci, chondroid metaplasia, and hyalinosis were observed within the wall. The distal anastomotic sites had hyperplastic neointima, partially covered with the endothelium. The wall of GA-BJV was stiff and rigid with degenerative changes, a substantial amount of calcium deposits and dense fibrotic formations in adventitia. An irregular neointimal layer was presented in the anastomotic sites without endothelial cover in the GA BJV wall. These results demonstrate that DE treatment improves conduit integration and the endothelialization of the inner surface while preventing the mineralization of the BJV, which may reduce the risk of early conduit dysfunction.
Collapse
Affiliation(s)
- Nataliya R. Nichay
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
- Cardiovascular Department, Novosibirsk State Medical University, Ministry of Health of Russian Federation, 52 Krasny Prospect, Novosibirsk 630091, Russia
| | - Anna A. Dokuchaeva
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Yuriy Yu. Kulyabin
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Evgeniy V. Boyarkin
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Elena V. Kuznetsova
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Yanina L. Rusakova
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Ivan S. Murashov
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Andrey A. Vaver
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Alexander V. Bogachev-Prokophiev
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Irina Yu. Zhuravleva
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| |
Collapse
|
3
|
Carrel T. Past, present, and future options for right ventricular outflow tract reconstruction. Front Surg 2023; 10:1185324. [PMID: 37334202 PMCID: PMC10272445 DOI: 10.3389/fsurg.2023.1185324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/17/2023] [Indexed: 06/20/2023] Open
Abstract
The pulmonary valve is the most frequently replaced cardiac valve in congenital heart diseases. Whether the valve alone or part of the right ventricular outflow tract have to be repaired or replaced depends on the specific pathological anatomy of the malformation. Once the decision to replace the pulmonary valve has been made, two options are available: the isolated transcatheter pulmonary valve replacement and the surgical implantation of a prosthetic valve either isolated or in combination with a procedure on the right ventricular outflow tract. In this paper, we will focus on the different past and present surgical options and present a new concept called "endogenous tissue restoration," a promising alternative to the hitherto existing implants. From a general point of view, neither the transcatheter nor the surgical valvular implants are magic bullets in the arsenal for the management of valvular diseases. Smaller valves have to be frequently replaced because of outgrowth of the patients, larger tissue valves may present late structural valve deterioration, while xenograft and homograft conduits may calcify and therefore become narrowed within unpredictable incidence and interval following implantation. Based on long-term research efforts combining the knowledge of supramolecular chemistry, electrospinning, and regenerative medicine, endogenous tissue restoration has emerged most recently as a promising option to create long-term functioning implants. This technology is appealing because following resorption of the polymer scaffold and timely replacement through autologous tissue, no foreign material remain at all in the cardiovascular system. Proof-of-concept studies as well as small first-in-man series have been completed and have demonstrated favorable anatomic and hemodynamic results, comparable to currently available implants in the short term. Based on the initial experience, important modifications to improve the pulmonary valve function have been initiated.
Collapse
|
4
|
Peivandi AD, Martens S, Asfour B, Martens S. Grafts and Patches: Optimized but Not Optimal Materials for Congenital Heart Surgery. Pediatr Cardiol 2023; 44:996-1002. [PMID: 37038028 PMCID: PMC10224861 DOI: 10.1007/s00246-023-03153-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/20/2023] [Indexed: 04/12/2023]
Abstract
A variety of materials are available for the surgery of children with congenital heart defects. In addition to growth-related mismatch, degeneration of the material in particular frequently leads to reoperation. Therefore, the choice of conduits and patches should be made carefully. This article provides an overview of the most commonly implanted materials in pediatric cardiac surgery.Structural changes can be detected in all available materials. Depending on the age at implantation and the site of implantation, the extent and time course of material degeneration vary. Autologous material is still the gold standard in reconstructive surgery. Biological materials have largely replaced artificial materials in clinical use.The search for the ideal material continues. In pediatric cardiac surgery, there are only optimized but no optimal materials.
Collapse
Affiliation(s)
- Armin Darius Peivandi
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Sven Martens
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Boulos Asfour
- Department of Pediatric Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Sabrina Martens
- Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, University Hospital Muenster, Muenster, Germany.
| |
Collapse
|
5
|
Lewis MJ, Malm T, Hallbergson A, Nilsson F, Ramgren JJ, Tran K, Liuba P. Long-Term Follow-Up of Right Ventricle to Pulmonary Artery Biologic Valved Conduits Used in Pediatric Congenital Heart Surgery. Pediatr Cardiol 2023; 44:102-115. [PMID: 35780430 PMCID: PMC9852178 DOI: 10.1007/s00246-022-02956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/11/2022] [Indexed: 01/24/2023]
Abstract
Valved conduit reconstruction between the right ventricle (RV) and the pulmonary circulation is often necessary in the surgical treatment of complex congenital heart defects. The aim of this study is to evaluate the long-term performance of the three types of conduits we have used and assess risk factors for conduit failure. Retrospective, single-center review of 455 consecutive pediatric patients with 625 conduits from 1990 to 2019 undergoing RV-to-pulmonary artery (PA) reconstruction with a valved conduit. The three conduit types investigated were pulmonary homograft, aorta homograft, and bovine jugular vein (BJV) graft. Overall patient survival was 91.4%, freedom from conduit replacement (FCR) was 47.4%, and freedom from reintervention (FFR) was 37.8% with a median follow-up of 8.7 years (interquartile range 4.3-13.3 years). For pulmonary homografts, 10-, 20-, and 28-year FCR was 79.6%, 68.6%, and 66.0%, respectively. For aortic homografts, 10-, 20-, and 30-year FCR was 49.8%, 31.5%, and 23.0%, respectively. For BJV grafts, 10- and 19-year FCR was 68.1% and 46.0%, respectively. When controlling for baseline variables, FCR was similar for pulmonary homografts and BJV grafts. Overall patient survival was excellent. Risk factors for conduit failure in patients operated with reconstruction of the RV-PA outflow tract included low age, low weight, small conduit size, and certain cardiac diagnoses. There was no evidence for a shorter life span of the second graft. Pulmonary homografts and BJV grafts performed similarly but the risk of endocarditis was greater in the BJV group.
Collapse
Affiliation(s)
- Michael J Lewis
- Divisions of Cardiac Surgery, Pediatric Heart Center, University Hospital, S-221 85, Lund, Sweden.
| | - Torsten Malm
- Divisions of Cardiac Surgery, Pediatric Heart Center, University Hospital, S-221 85, Lund, Sweden
- Divisions of Tissue Bank, Pediatric Heart Center, University Hospital, Lund, Sweden
- Department of Clinical Science, Lund University, Lund, Sweden
| | - Anna Hallbergson
- Divisions of Cardiology, Pediatric Heart Center, University Hospital, Lund, Sweden
| | - Fredrik Nilsson
- Department of Dermatology, Skåne University Hospital, Landskrona, Sweden
| | - Jens Johansson Ramgren
- Divisions of Cardiac Surgery, Pediatric Heart Center, University Hospital, S-221 85, Lund, Sweden
| | - Kiet Tran
- Divisions of Cardiac Surgery, Pediatric Heart Center, University Hospital, S-221 85, Lund, Sweden
| | - Petru Liuba
- Divisions of Cardiology, Pediatric Heart Center, University Hospital, Lund, Sweden
- Department of Clinical Science, Lund University, Lund, Sweden
| |
Collapse
|
6
|
Zhuravleva IY, Karpova EV, Dokuchaeva AA, Kuznetsova EV, Vladimirov SV, Ksenofontov AL, Nichay NR. Bovine jugular vein conduit: What affects its elastomechanical properties and thermostability? J Biomed Mater Res A 2021; 110:394-408. [PMID: 34390309 DOI: 10.1002/jbm.a.37296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 12/12/2022]
Abstract
The aim of this study was to compare the mechanical properties and thermal stability of the venous wall depending on the treatment method used, and, accordingly, on those structural changes in the tissue that this treatment causes. Bovine jugular vein walls (BJVWs) cross-linked with glutaraldehyde (GA), ethylene glycol diglycidyl ether (DE), and Contegra commercial conduit were evaluated using uniaxial stretching [with and without pre-conditioning (PreC)], differential scanning calorimetry, amino acid analysis, and attenuated total reflection infrared spectroscopy. Fresh BJVW was used as a control. It was shown that failure stress in non-PreC GA-treated and DE-treated materials was lower than that in fresh and Contegra counterparts. Contegra samples were the stiffest among the tested materials. Cyclic preloading leads to distortion of the mechanical behavior of this material, which is heterogeneous in composition and structure. The denaturation temperatures (Td ) of all cross-linked BJVWs were higher than the Td of the fresh vein. The microstructures of the tested BJVWs did not exhibit any differences, but the cross-linking density and hydration of the DE-vein were the highest. GA-cross-linking or DE-cross-linking and isopropanol exposure (Contegra) changed the protein secondary structures of the tested materials in different ways. We hypothesized that the protein secondary structure and hydration degree are the main causes of differences in the mechanical properties and thermal stability of BJVW.
Collapse
Affiliation(s)
- Irina Yu Zhuravleva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| | - Elena V Karpova
- N.N. Vorozhtsov Novosibirsk Institute of Organic Chemistry SB RAS, Novosibirsk, Russian Federation
| | - Anna A Dokuchaeva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| | - Elena V Kuznetsova
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| | - Sergei V Vladimirov
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| | - Alexander L Ksenofontov
- A. Belozersky Research Institute of Physico-Chemical Biology MSU, Moscow, Russian Federation
| | - Natalia R Nichay
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| |
Collapse
|
7
|
Burghuber CK, Konzett S, Eilenberg W, Nanobachvili J, Funovics MA, Hofmann WJ, Neumayer C, Domenig CM. Novel prefabricated bovine pericardial grafts as alternate conduit for septic aortoiliac reconstruction. J Vasc Surg 2020; 73:2123-2131.e2. [PMID: 33278536 DOI: 10.1016/j.jvs.2020.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Infection of prosthetic aortic grafts represents a serious complication with high morbidity and mortality. Replacement with autologous material is recommended; however, in its absence, biological material should be favored. In the present retrospective cohort study, we evaluated the short- and midterm results with the use of commercially available prefabricated bovine pericardium grafts (BPGs) used for the management of aortic graft infection or aortic reconstructive surgery in the presence of systemic infection. METHODS We performed a retrospective analysis of patients in whom BPGs had been used for aortic reconstruction at two vascular centers. Prefabricated vascular pericardium grafts were preferred over other biological reconstruction techniques for selected cases. Comorbidities, procedure-related details, perioperative morbidity, clinical outcomes, and mortality were analyzed. RESULTS From 2014 to 2019, 21 patients had received BPGs at two Austrian vascular centers. Their median age was 63 years (interquartile range [IQR], 55-71 years), the patients were predominantly male (76%), and the median body mass index was 25.3 kg/m2 (IQR, 21.7-27.3 kg/m2). The major comorbidities included arterial hypertension, peripheral artery disease, smoking, and chronic pulmonary disease. The indications for surgery were vascular graft or endograft infection in 62% and aortic reconstruction in the presence of systemic infection in 38%. Three patients (14%) had aortoenteric fistulas. Surgery was technically successful in all cases. The median follow-up was 21.6 months (IQR, 6.0-34.6 months). The 30-day mortality was 9.5%. The 1- and 2-year overall survival was 84% and 75%, respectively. Of the 21 patients, 89% had remained free of recurrent infection. One of the two reinfections had resolved after treatment of the underlying focus. At 2 years, the primary and assisted primary patency rates were 86% and 94%, respectively. No limbs were lost during follow-up. CONCLUSIONS Prefabricated BPGs represent a promising alternative for the management of aortic graft infections and aortoiliac reconstruction in the presence of systemic infection.
Collapse
Affiliation(s)
- Christopher K Burghuber
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Sophie Konzett
- Department of Vascular Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Wolf Eilenberg
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Josif Nanobachvili
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin A Funovics
- Division of Angiography and Interventional Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang J Hofmann
- Department of Vascular Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph M Domenig
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
8
|
Abstract
OBJECTIVES The Ross procedure involves using the native pulmonary valve for aortic valve replacement then replacing the pulmonary valve with an allograft or xenograft. We aimed to compare our age-matched experience with the bovine jugular vein conduit and the pulmonary homograft for pulmonary valve replacement during the Ross procedure in children. METHODS Between 1998 and 2016, 15 patients <18 years of age underwent a Ross procedure using the bovine jugular vein conduit (Ross-Bovine Jugular Vein Conduit) at our institution. These patients were age-matched with 15 patients who had the Ross operation with a standard pulmonary homograft for right ventricular outflow tract reconstruction (Ross-Pulmonary Homograft). Paper and electronic medical records were retrospectively reviewed. RESULTS The median age of the Ross-Bovine Jugular Vein Conduit and Ross-Pulmonary Homograft patients were 4.8 years (interquartile range 1.1-6.6) and 3.3 years (interquartile 1.2-7.6), respectively (p = 0.6). The median follow-up time for the Ross-Bovine Jugular Vein Conduit and Ross-Pulmonary Homograft groups were 1.7 years (interquartile range 0.5-4.9) and 6.8 years (interquartile range 1.9-13.4), respectively (p = 0.03). Overall, 5-year survival, freedom from redo aortic valve replacement, and freedom from pulmonary valve replacement were similar between groups. CONCLUSION The bovine jugular vein conduit and pulmonary homograft have favourable mid-term durability when used for right ventricular outflow tract reconstruction for the Ross operation. The bovine jugular vein conduit may be a suitable replacement for appropriately sized patients undergoing a Ross aortic valve replacement, though longer follow-up is needed.
Collapse
|
9
|
Nichay NR, Zhuravleva IY, Kulyabin YY, Zubritskiy AV, Voitov AV, Soynov IA, Gorbatykh AV, Bogachev-Prokophiev AV, Karaskov AM. Diepoxy- Versus Glutaraldehyde-Treated Xenografts: Outcomes of Right Ventricular Outflow Tract Reconstruction in Children. World J Pediatr Congenit Heart Surg 2019; 11:56-64. [PMID: 31835985 DOI: 10.1177/2150135119885900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Xenografts used for right ventricular outflow tract (RVOT) reconstruction are typically treated with glutaraldehyde. However, potential benefit of epoxy treatment was demonstrated in experimental studies. We aimed to compare diepoxy-treated bovine pericardial valved conduits (DE-PVCs) and glutaraldehyde-treated bovine pericardial valved conduits (GA-PVCs) for RVOT reconstruction in pediatric patients. METHODS Between 2002 and 2017, 117 patients underwent RVOT reconstruction with PVC in single center: DE-PVC group, n = 39; and GA-PVC group, n = 78. After performing propensity score analysis (1:1) for the entire sample, 29 patients from the DE-PVC group were matched with 29 patients from the GA-PVC group. RESULTS There were no conduit-related deaths. In the DE-PVC group, the freedom from conduit failure was 90.9% at four years and 54.3% at eight years postoperatively. In the GA-PVC group, it was 46.3% and 33.1%, respectively. The difference was significant (P = .037). Conduit failure was typically caused by stenosis in both groups. In the DE-PVC group, the main cause of stenosis was xenograft calcification (27.6%); while in the GA-PVC group, it was mostly due to neointimal proliferation (25.0%) and, less often, calcification (14.3%). Conduit thrombosis was the cause of replacement in 6.9% of patients from the GA-PVC group. CONCLUSIONS Diepoxy-treated bovine pericardial valved conduit is a suitable alternative to GA-PVC for RVOT reconstruction in pediatric patients. Diepoxy-treated bovine pericardial valved conduits may be less prone to conduit failure and more resistant to neointimal proliferation and conduit thrombosis than GA-PVCs.
Collapse
Affiliation(s)
- Nataliya R Nichay
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Irina Y Zhuravleva
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Yuriy Y Kulyabin
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Alexey V Zubritskiy
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Alexey V Voitov
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Ilia A Soynov
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Artem V Gorbatykh
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Alexander V Bogachev-Prokophiev
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Alexander M Karaskov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| |
Collapse
|
10
|
Yamamoto Y, Yamagishi M, Maeda Y, Asada S, Hongu H, Fujita S, Yaku H. Histopathologic Analysis of Explanted Polytetrafluoroethylene-Valved Pulmonary Conduits. Semin Thorac Cardiovasc Surg 2019; 32:990-999. [PMID: 31606427 DOI: 10.1053/j.semtcvs.2019.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022]
Abstract
The expanded polytetrafluoroethylene (ePTFE)-valved conduits as alternative material for right ventricular outflow reconstruction provides satisfactory long-term outcomes. The purpose of this study was to investigate degenerative changes in failed conduits through histopathologic analysis of the explanted specimens. All leaflets of explanted conduits were observed macroscopically, and their longitudinal sections were examined microscopically. Three typical findings, that is, calcification of the leaflet, neointimal proliferation, and proteinaceous infiltration into the leaflet, were evaluated quantitatively by measuring their degree and appearance probability. A total of 15 leaflets from 5 failed conduits (group F) and 12 leaflets from 5 nonfailed conduits (group non-F) were included. The median duration of implantation was 7.6 years (5.3-10.9 years) in group F and 1.3 years (0.7-3.9 years) in group non-F (P = 0.003). In group F, calcification tended to occur in the middle and upper third of the leaflet, causing stiffening, distortion, and exophytic concretion of the leaflet, and mean neointimal thickness on inflow and outflow surfaces were 0.33 ± 0.02 mm and 0.22 ± 0.01 mm, respectively. There was a moderately strong correlation between appearance probability of calcification in group F and that of proteinaceous infiltration in group non-F (correlation coefficient 0.67, P < 0.001). Proteinaceous infiltration into the leaflet was presumed be responsible for future calcification of the leaflet and subsequent stenotic conduit failure. Modification of the ePTFE material to prevent proteinaceous infiltration may contribute to improving the durability of ePTFE-valved conduit.
Collapse
Affiliation(s)
- Yusuke Yamamoto
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| |
Collapse
|
11
|
Peivandi AD, Seiler M, Mueller KM, Martens S, Malec E, Asfour B, Lueck S. Elastica degeneration and intimal hyperplasia lead to Contegra® conduit failure. Eur J Cardiothorac Surg 2019; 56:1154-1161. [DOI: 10.1093/ejcts/ezz199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/04/2019] [Accepted: 06/09/2019] [Indexed: 02/04/2023] Open
Abstract
Abstract
OBJECTIVES
Currently, Contegra® grafts (processed bovine jugular vein conduits) are widely used for reconstructive surgery of the right ventricular outflow tract in patients with congenital heart disease (CHD). We analysed explanted Contegra conduits from 2 institutions histologically to get a possible hint at the underlying pathomechanisms of degenerative alterations and to find histological correlations of graft failure. Additionally, we compared the explants with a non-implanted processed graft and a native jugular vein obtained from a young bull.
METHODS
The explanted Contegra grafts were gathered during reoperations of 13 patients (male: n = 9, 69.2%; female: n = 4, 30.8%). After standardized histological preparation, samples were stained with dyes haematoxylin and eosin and Elastica van Gieson. Additionally, X-ray pictures revealed the extent of calcification and chelaplex (III)-descaling agent was used to decalcify selected explants.
RESULTS
Processing of the native jugular vein leads to tissue loosening and a loss of elastic fibres. For graft failure after implantation, 2 pathomechanisms were identified: original graft alteration as well as intimal hyperplasia. Elastica degeneration and rearrangement with interfibrillary matrix structures were the main developments observed within the graft itself. Intimal hyperplasia was characterized by fibrous tissue apposition, calcification and heterotopic ossification.
CONCLUSIONS
Regression of the elastic fibre network leads to rigidification of the conduit. In Contegra grafts, atherosclerosis-like changes can be considered the leading cause of graft stenosis and insufficiency. We conclude that both observed mechanisms lead to early reoperation in CHD patients.
Collapse
Affiliation(s)
- Armin Darius Peivandi
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Martina Seiler
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Klaus-Michael Mueller
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Sven Martens
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Edward Malec
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Boulos Asfour
- Department of Pediatric Cardiac and Thoracic Surgery, German Pediatric Heart Center, Sankt Augustin, Sankt Augustin, Germany
| | - Sabrina Lueck
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
12
|
Modification of expanded polytetrafluoroethylene valved conduit using the thin-type leaflets. J Thorac Cardiovasc Surg 2018; 156:1629-1636.e3. [DOI: 10.1016/j.jtcvs.2018.04.107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 11/18/2022]
|
13
|
Patel PM, Tan C, Srivastava N, Herrmann JL, Rodefeld MD, Turrentine MW, Brown JW. Bovine Jugular Vein Conduit: A Mid- to Long-Term Institutional Review. World J Pediatr Congenit Heart Surg 2018; 9:489-495. [DOI: 10.1177/2150135118779356] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Since 1999, we have used the bovine jugular vein conduit for right ventricular outflow tract reconstruction in infants and children. Herein, we review their mid- to long-term outcomes. Methods: Between 1999 and 2016, 315 bovine jugular vein conduits were implanted in 276 patients. Patients were grouped by age at bovine jugular vein conduit implant: group 1: 0 to 1 years (N = 65), group 2: one to ten years (N = 132), and group 3: older than ten years (N = 118). For survival and hemodynamic analysis, additional group stratification was done based on conduit size. Group small: 12 and 14 mm (N = 75), group medium: 16 and 18 mm (N = 84), and group large: 20 and 22 mm (N = 156). Results: Mean follow-up for groups 1, 2, and 3 was 4.0, 4.9, and 5.9 years, respectively. Early mortality was 9%, 0%, and 1% for groups 1, 2, and 3, respectively ( P < .001). Late mortality was 5%, 2%, and 2% for groups 1, 2, and 3, respectively ( P = .337). Group 1 had the lowest ten-year freedom from conduit failure at 13%, versus 53% and 69% for groups 2 and 3, respectively ( P < .001). A total of 21 (6.6%) patients developed endocarditis, 11 (3.5%) patients required reoperation, and 10 (3.2%) patients required antibiotic therapy alone. Conclusions: The bovine jugular vein conduit is a useful option for right ventricular outflow tract reconstruction given its easy implantability and acceptable midterm durability.
Collapse
Affiliation(s)
- Parth M. Patel
- Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Corinne Tan
- Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nayan Srivastava
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeremy L. Herrmann
- Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark D. Rodefeld
- Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark W. Turrentine
- Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John W. Brown
- Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
14
|
Murala JS, Vela RJ, Geoffrion T, Chopra S, Guhathakurtha S, Pezzella T, Cherian KM. Right ventricular outflow tract obstruction: a quest for ideal management. Asian Cardiovasc Thorac Ann 2018; 26:451-460. [PMID: 29860893 DOI: 10.1177/0218492318779963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Management of right ventricular outflow tract obstruction has undergone much change over the last century. Techniques described in the literature include anatomical repairs and the use of various patches, conduits, and innovative grafts. However, many of these approaches require reoperations or catheter-based interventions, leading to increased morbidity, mortality, and cost. The search for the ideal long-lasting conduit continues and there are new techniques on the horizon, using genetic engineering and nanotechnology. This review discusses the evolution of various techniques for repair of right ventricular outflow tract obstruction, past and current conduits, as well as ongoing research.
Collapse
Affiliation(s)
- John Sk Murala
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ryan J Vela
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tracy Geoffrion
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Surpreet Chopra
- 2 Department of Cardiovascular and Thoracic Surgery, Government Medical College and Super Specialty Hospital, Nagpur, India
| | - Soma Guhathakurtha
- 3 Department of Engineering Design, Indian Institute of Technology Chennai, India
| | - Thomas Pezzella
- 4 International Children's Heart Fund, Boca Raton, Florida, USA
| | | |
Collapse
|
15
|
Nichay NR, Zhuravleva IY, Kulyabin YY, Timchenko TP, Voitov AV, Kuznetsova EV, Soynov IA, Zubritskiy AV, Bogachev-Prokophiev AV, Karaskov AM. In search of the best xenogeneic material for a paediatric conduit: an analysis of clinical data†. Interact Cardiovasc Thorac Surg 2018; 27:34-41. [DOI: 10.1093/icvts/ivy029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/16/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nataliya R Nichay
- Department of Congenital Heart Disease, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Irina Y Zhuravleva
- Laboratory of Biological Prosthetics, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Yuriy Y Kulyabin
- Department of Congenital Heart Disease, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Tatyana P Timchenko
- Laboratory of Biological Prosthetics, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey V Voitov
- Department of Congenital Heart Disease, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Elena V Kuznetsova
- Laboratory of Biological Prosthetics, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Ilia A Soynov
- Department of Congenital Heart Disease, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey V Zubritskiy
- Department of Congenital Heart Disease, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | | | - Alexander M Karaskov
- Department of Heart Valve Surgery, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| |
Collapse
|
16
|
Choi KH, Sung SC, Kim H, Lee HD, Kim G, Ko H. Late results of right ventricular outflow tract reconstruction with a bicuspid expanded polytetrafluoroethylene valved conduit. J Card Surg 2018; 33:36-40. [PMID: 29314335 DOI: 10.1111/jocs.13507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM TO READ We report the results of a bicuspid expanded polytetrafluoroethylene (ePTFE) valved conduit used for right ventricular outflow tract reconstruction (RVOTR). METHODS Between November 2005 and February 2009, 12 conduits were used for RVOTR. The mean age and weight of patients were 43.5 ± 46.4 months and 13.4 ± 8.6 kg. The main diagnosis was tetralogy of Fallot with pulmonary atresia in eight patients. The most common conduit size was 18 mm. The mean follow-up was 88.0 ± 35.9 months. RESULTS There were no operative and late mortalities. At discharge, the mean peak systolic pressure gradient across the RVOT was 14.1 ± 11.3 mmHg. There was no conduit valve regurgitation in nine patients. At the latest echocardiography (mean follow-up: 84.3 ± 35.5 months), the mean peak systolic pressure gradient across the RVOT was 59.7 ± 20.2 mmHg, and there was no conduit valve regurgitation in six patients. Freedom from conduit malfunction was 100% and 83.3%, at 1 and 8 years, respectively. Two conduits were explanted due to sternal compression and four from conduit malfunction. Freedom from explantation was 83.3% and 74.2% at 2 and 8 years, respectively. CONCLUSIONS ePTFE bicuspid valved conduit has good late function in terms of valve regurgitation, but the pressure gradient across the conduit increases with time, which is the main cause of conduit failure and explantation.
Collapse
Affiliation(s)
- Kwang Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea
| | - Si Chan Sung
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea
| | - Hyungtae Kim
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea
| | - Hyoung Doo Lee
- Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Geena Kim
- Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Hoon Ko
- Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| |
Collapse
|
17
|
Zhang HF, Ye M, Yan XG, Chen G, Tao QL, Jia B. Application of a Simplified Hand-Sewn Trileaflet Valved Conduit in Right Ventricular Outflow Tract Reconstruction as an Alternative for Bovine Jugular Vein Graft: Single-Center Experience. Artif Organs 2017; 42:41-48. [PMID: 28971487 DOI: 10.1111/aor.12968] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/11/2017] [Accepted: 04/25/2017] [Indexed: 11/27/2022]
Abstract
The Bovine jugular vein (BJV) graft for right ventricular outflow tract reconstruction (RVOT) is limited applied due to possible graft failure. In this study, we reported the clinical application of simplified hand-sewn trileaflet valved conduit as an alternative for BJV graft. We retrospectively included 68 patients underwent 76 conduits implantation including 22 new simplified hand-sewn trileaflet valved conduits (Group A) and 54 BJV grafts (Group B). For patients in Group A, a hand-sewn trileaflet valved conduit with valves made of autologous pericardium or expanded polytetrafluoroethylene was applied. Baseline, perioperative, and outcomes were analyzed. No early mortality or perioperative complication occurred in Group A, while 2 patients died and 16 patients suffered from conduits failure due to conduits stenosis (n = 11), stenosis plus regurgitation (n = 3), and regurgitation alone (n = 2) in Group B. Freedom from BJV grafts failure within 1, 3, 5, and 7 years was 98.0%, 88.2%, 83.6% and 83.6% in Group A, and 98.0%, 85.8%, 76.8% and 62.1% in Group B. Endocarditis occurred in 9 patients in Group B, but not in Group A. Subsequent analysis showed that endocarditis is the only significant predictor of BJV grafts failure (odds ratio: 6.202, 95% confidence intervals 1.237∼31.108). The novel simplified hand-sewn trileaflet valved conduits seems to be associated with lower incidences of perioperative complication, graft failure, and early-phase mortality, as compared with conventional BJV grafts.
Collapse
Affiliation(s)
- Hui-Feng Zhang
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Ming Ye
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Xian-Gang Yan
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Gang Chen
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Qi-Lin Tao
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Bing Jia
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China
| |
Collapse
|
18
|
Zhang HF, Chen G, Ye M, Yan XG, Tao QL, Jia B. Mid- to long-term outcomes of bovine jugular vein conduit implantation in Chinese children. J Thorac Dis 2017; 9:1234-1239. [PMID: 28616273 DOI: 10.21037/jtd.2017.05.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bovine jugular vein (BJV) conduits are widely applied for surgical reconstruction of the right ventricular outflow tract (RVOT). However, relevant studies of valve failure rates and the related risk factors are limited in China. The aim of this study was to assess the BJV prognosis after medium- to long-term follow-up. METHODS Fifty-three hospital patients implanted with BJV conduits from January 2002 to December 2013 were recruited. Patient information and follow-up prognosis were reviewed retrospectively. Conduit stenosis and failure as well as endocarditis were diagnosed. RESULTS The total person years was 345.5, and the median follow-up time was 6.3 years. Early mortality occurred in two patients, and there was no late mortality. BJV conduit failure occurred in 15 patients (29.4%) due to severe stenosis (n=10), stenosis plus regurgitation (n=3), and regurgitation alone (n=2). The proportion of patients who were free of BJV conduit failure at 1, 3, 5, and 7 years was 98.0%, 85.8%, 76.8%, and 62.1%, respectively. There were nine cases of endocarditis (17.0%). Multivariate logistic regression analysis showed that endocarditis was a significant risk factor associated with BJV conduit failure (OR: 6.735; 95% CI: 1.348-33.647). CONCLUSIONS The durability of BJV conduits was suboptimal after a mid-term follow-up period. Endocarditis was found to be a significant risk factor that accelerates BJV conduit deterioration.
Collapse
Affiliation(s)
- Hui-Feng Zhang
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Gang Chen
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Ming Ye
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Xian-Gang Yan
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Qi-Lin Tao
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Bing Jia
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
| |
Collapse
|
19
|
Prótesis pulmonar porcina versus yugular bovina para reparar el tracto de salida del ventrículo derecho en menores con cardiopatía congénita. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
20
|
Yamamoto Y, Yamagishi M, Miyazaki T. Current status of right ventricular outflow tract reconstruction: complete translation of a review article originally published in Kyobu Geka 2014;67:65-77. Gen Thorac Cardiovasc Surg 2014; 63:131-41. [PMID: 25503561 DOI: 10.1007/s11748-014-0500-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Indexed: 01/14/2023]
Abstract
Right ventricular outflow tract (RVOT) reconstruction is becoming more prevalent as the number of adult patients who require repeated surgery long after definitive repair of congenital heart defects during childhood has increased. Early primary repair and annulus-preserving surgery have been the two current strategies of RVOT reconstruction from the viewpoint of timing and indications for surgical intervention; however, the long-term outcomes of both procedures remain unknown. Although various materials have been used for pulmonary valve replacement during RVOT reconstruction, deficient durability due primarily to immunological rejection frequently arises, particularly when implanted into young patients. A multicenter study in Japan showed that the clinical outcomes of expanded polytetrafluoroethylene (ePTFE) valved patches/conduits that we developed and manufactured comprised an excellent alternative material for RVOT reconstruction. Such enhanced outcomes might have partly been attributable to the biocompatibility and low antigenicity of ePTFE, and also to the fluid dynamic properties arising from the structural characteristics of a bulging sinus and a fan-shaped valve. However, numerous issues concerning RVOT reconstruction, such as indications for and the timing of definitive repair, as well as the choice of materials for pulmonary valve replacement, must be resolved to achieve better patient prognoses and quality of life. This review describes recent surgical strategies and outstanding issues associated with RVOT reconstruction.
Collapse
Affiliation(s)
- Yusuke Yamamoto
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan,
| | | | | |
Collapse
|
21
|
Tenisch EV, Alamo LT, Sekarski N, Hurni M, Gudinchet F. MR and CT imaging of pulmonary valved conduits in children and adolescents: normal appearance and complications. Pediatr Radiol 2014; 44:1518-31. [PMID: 25030219 DOI: 10.1007/s00247-014-3057-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 03/03/2014] [Accepted: 05/14/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Contegra® is a conduit made from the bovine jugular vein and then interposed between the right ventricle and the pulmonary artery. It is used for cardiac malformations in the reconstruction of right ventricular outflow tract. OBJECTIVE To describe both normal and pathological appearances of the Contegra® in radiological imaging, to describe imaging of complications and to define the role of CT and MRI in postoperative follow-up. MATERIALS AND METHODS Forty-three examinations of 24 patients (17 boys and 7 girls; mean age: 10.8 years old) with Contegra® conduits were reviewed. Anatomical description and measurements of the conduits were performed. Pathological items examined included stenosis, dilatation, plicature or twist, thrombus or vegetations, calcifications and valvular regurgitation. Findings were correlated to the echographic gradient through the conduit when available. RESULTS CT and MR work-up showed Contegra® stenosis (n = 12), dilatation (n = 9) and plicature or twist (n = 7). CT displayed thrombus or vegetations in the Contegra® in three clinically infected patients. Calcifications of the conduit were present at CT in 12 patients and valvular regurgitation in three patients. The comparison between CT and/or MR results showed a good correlation between the echographic gradient and the presence of stenosis in the Contegra®. CONCLUSION CT and MR bring additional information about permeability and postoperative anatomy especially when echocardiography is inconclusive. Both techniques depict the normal appearance of the conduit, and allow comparison and precise evaluation of changes in the postoperative follow-up.
Collapse
Affiliation(s)
- Estelle V Tenisch
- Department of Medical Imaging, Lausanne University Hospital, rue du Bugnon 46, 1012, Lausanne, Switzerland,
| | | | | | | | | |
Collapse
|
22
|
Padalino MA, Vida VL, Rito ML, Daliento L, Stellin G. The role of cardiac surgery in adult patients with congenital heart disease. J Cardiovasc Med (Hagerstown) 2013; 14:326-33. [DOI: 10.2459/jcm.0b013e3283542eec] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
23
|
Perri G, Polito A, Esposito C, Albanese SB, Francalanci P, Pongiglione G, Carotti A. Early and late failure of tissue-engineered pulmonary valve conduits used for right ventricular outflow tract reconstruction in patients with congenital heart disease. Eur J Cardiothorac Surg 2012; 41:1320-5. [DOI: 10.1093/ejcts/ezr221] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|