The fate of antibiotic sterilized aortic allografts in Fontan circulation:results of the long-term follow-up

Objective: Between 1977 and 1988, 27 patients, mean age 8.9 (range 4-22) re ceived an antibiotic sterilised aortic allograft in the setting of the Font an procedure. This study describes the long-term follow-up of these patient s. Methods: Fifteen patients had tricuspid atresia, nine double inlet ventr icles and three others. The connection with the allograft was made to the p ulmonary artery on the right side of the aorta in ten and to a left-sided m ain pulmonary artery in eight. In nine patients the allograft was anastomos ed between the right atrium and the right ventricle. Results: There were fi ve early and five late deaths. One late death may have been allograft relat ed. Survival was 81,74 and 68% at 5, 10 and 15 years, respectively. Conduit calcification was universal. Twelve patients underwent reoperation, freedo m from reoperation was 100, 88 and 54% at 5,10 and 15 years following the i nitial Fontan procedure. At reoperation the gradient across the allograft w as never more than 3 mmHg. The allograft was explanted with conversion to a triopulmonary or cavopulmonary connection in nine and a second allograft wa s inserted between the right atrium and right ventricle in two. No mortalit y occurred at reoperation. 41.1% of survivors still have their original all ograft. Conclusions: Although there is a significant attrition rate allogra ft inclusion in the Fontan circulation does not change survival, but result s in an increased reoperation rate. Inclusion of a valved conduit between t he right atrium and ventricle does not usually enhance the growth potential of the rudimentary ventricle. Ail patients are in a good functional class which may represent the strict original selection criteria. The inclusion o f a valve in the Fontan circulation is not recommended. (C) 1999 published by Elsevier Science B.V. All rights reserved.