ASCENDING AORTIC EXTENSION FOR RIGHT PULMONARY-ARTERY STENOSIS ASSOCIATED WITH VENTRICULAR-TO-PULMONARY ARTERY CONDUIT REPLACEMENT

Background: Ventricular-to-pulmonary artery conduits in growing patien ts with congenital heart disease will require replacement from time to time due to somatic growth, neointimal hyperplasia, and pulmonary art ery stenosis, The purpose of this article is to review our experience with ascending aortic extension for significant long-segment pulmonary artery stenosis in patients undergoing reoperation for Fight ventricu lar-to-pulmonary artery conduit replacement. Methods: From 1989 to 199 7, 8 patients had aortic transection, right pulmonary artery augmentat ion arterioplasty, and aortic interposition graft (Hemashield in 7 and Gore-tex in 1) in association with right ventricular-to-pulmonary art ery conduit replacement in 7 patients and completion Fontan operation in 1 patient. Aortic cross-clamp time was 90 +/- 34 minutes, and the c ardiopulmonary bypass time was 205 +/- 37 minutes. Results: All patien ts survived. In those 7 patients who had conduit replacement, the RV/L V ratio declined from 0.78 +/- 0.15 to 0.45 +/- 0.05 postoperatively ( P < 0.05), Average length of stay was 8.9 +/- 7.2 days. Follow-up rang e is 18 months to 8 years (mean 4 years). Two complications included c ardiac transplantation for pre-existing poor left ventricular function and accelerated conduit stenosis leading to conduit re-replacement. C onclusion: Ascending aortic extension facilitates long-segment pulmona ry artery augmentation arterioplasty and enlarges the retroaortic spac e, preventing future compression restenosis.