RESULTS OF AN AUTOLOGOUS TISSUE RECONSTRUCTION FOR REPLACEMENT OF OBSTRUCTED EXTRACARDIAC CONDUITS

Between May 1983 and March 1, 1995, 50 patients had replacement of an obstructed pulmonary ventricle-pulmonary artery conduit with an autolo gous tissue reconstruction in which a prosthetic roof was placed over the fibrous tissue bed of the explanted conduit, The roof was construc ted with xenograft pericardium (most recently) (n = 42), homograft dur a mater (n = 5), or Dacron fabric (n = 3), Patient ages ranged from 5 to 34 years (median 16 years), The explanted conduits were Hancock con duits (n = 33), Tascon conduits (n = 6), homograft (n = 4), Dacron tub e (n = 3),and others (n = 3), Preoperative maximum systolic gradients ranged from 44 to 144 mm Hg (median 78 mm Hg). Thirty-seven concomitan t cardiac procedures were done in 29 patients. When a valve was necess ary (n = 15), it was possible to place a large-sized valve in the auto logous tissue reconstructions (range 22 to 29 mm, median 26 mm). Cardi opulmonary bypass times ranged from 34 to 223 minutes (median 84 minut es), and aortic crossclamp times ranged from 0 (in 32 patients) to 109 minutes (median 0 minutes). Intraoperative postrepair peak systolic g radients from pulmonary ventricle to pulmonary artery ranged from 0 to 33 mm Hg (median 13 mm Hg). There was one early death (2%) in a patie nt who had additional cardiac procedures. Follow-up was complete in al l patients and ranged from 1 month to 11.8 years (median 7.5 years). T here were two sudden late deaths: conduits in both were known to be fr ee from obstruction. Forty-four of the 47 surviving patients had evalu ation of the gradient by echocardiography or cardiac catheterization 1 month to 11 years (median 7 years) after operation. The gradients ran ged from 5 to 45 mm Hg (median 20 mm Hg). None of the conduits develop ed an obstructive peel, valve obstruction, or valve incompetence. At 1 0 years, the freedom from reoperation for conduit obstruction was 100% , and freedom from reoperation for any cause was 81%. This technique s implifies conduit replacement, allows for a generous-sized outflow tra ct, has a low risk, and yields late results that appear superior to th ose of cryopreserved homografts or other types of extracardiac conduit s.