CLINICAL-RESULTS OF CRYOPRESERVED VALVED CONDUITS IN THE PULMONARY VENTRICLE-TO-PULMONARY ARTERY POSITION

Aortic valved homograft conduits (AVHC) have become valuable in the pu lmonary ventricle (PV)-to-main pulmonary artery (MPA) reconstruction i n congenital heart defects. Since 1985, 45 patients, ranging in age fr om 12 days to 32 years, underwent PV-to-MPA reconstruction utilizing c ryopreserved AVHC. Operative deaths included seven patients (16%), six of whom died as a result of the complexity of their underlying heart defects. One late death (2%) occurred as a result of infective endocar ditis 48 months after conduit placement. The 38 patients who survived the operation remained in the intensive care unit for a mean of 5.7 +/ - 1.0 days (median: 4 days; range: 2 to 37 days). The mean hospital st ay was 13.0 +/- 1.8 days (median: 9 days; range: 6 to 63 days). The me an follow-up was 40.0 +/- 3.6 months (median: 40 months; range: 10 mon ths to 7.1 years).Only two patients (5%) required reoperation for cond uit stenosis with systolic pressure gradients of 60 to 80 mm Hg at 10 and 14 months, respectively, after operation, and both reoperations we re successful. During outpatient visits, 16 patients are totally asymp tomatic, and 21 patients have minimal symptoms (New York Heart Associa tion class II). Only 10 patients (26%) require digoxin, and 2 patients (5%) need diuretics as part of their medical regimen. Recent echocard iographic examinations show insignificant pressure gradients in all 37 currently surviving patients. Thus, barring operative mortality, whic h is almost always associated with the nature of the underlying heart defect, the use of cryopreserved AVHC is a safe and effective alternat ive for PV-to-MPA reconstruction.