Homograft valved right ventricle to pulmonary artery conduit as a modification of the Norwood procedure

Article; Proceedings Paper

关键词: LEFT-HEART SYNDROME;    BLALOCK-TAUSSIG SHUNT;    INTERSTAGE MORTALITY;    PALLIATION;    OPERATION;    HEMODYNAMICS;    EXPERIENCE;    OUTCOMES;    SURGERY;    IMPACT;   

DOI  :  10.1161/CIRCULATIONAHA.105.001438

来源: SCIE

【 摘 要 】

Background - The use of a right ventricle to pulmonary artery (RV-PA) conduit in the Norwood procedure has been proposed to increase postoperative hemodynamic stability. A valve within the conduit should further decrease RV volume load. We report our clinical experience with this modification. Methods and Results - From February 2002 through August 2005, we performed 88 consecutive Norwood procedures using RV- PA conduits. We used composite valved conduits made from cryopreserved homograft and polytetrafluoroethylene (PTFE) in 66 cases (54 pulmonary, 12 aortic homografts), other valved conduits in 14, and unvalved PTFE in 8 cases. Hospital survival was 88.6% overall and increased to 93.1% after the initial year. Early interventions were required in 18 patients (16 for cyanosis). Prestage II cardiac catheterization was performed at a mean age of 126 days. Mean Qp/Qs was 1, with mean aortic saturation 71%, mean O-2 extraction 24%, and mean right ventricular end- diastolic pressure 9 mm Hg. Patient weight, use of an aortic homograft valve in the conduit, stage I palliation within the first year of our experience, and low O-2 extraction and high transpulmonary gradient prestage II were risk factors for overall death. Early interventions were more frequent in aortic valve conduits compared with all other conduits. Conclusions - The valved RV- PA conduit was associated with low early mortality after the Norwood procedure. The majority of these patients had normal cardiac output and well- maintained RV function. There may be a higher risk for early conduit interventions and death when aortic valve homografts are used in the RV- PA conduit.

【 授权许可】

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