COMPARATIVE ANALYSIS OF PULMONARY ARTERY CONDUITS IN CHILDREN

Highlights

The review presents the analysis of long-term outcomes of implantation of the most common types of conduits in children. Predictors of the development of dysfunction and infective endocarditis are presented.

Aim. To analyze the function of the available types of conduits in pediatric group of patients who underwent right ventricular outflow tract (RVOT) reconstruction.

Methods. The retrospective study included patients between 0 and 18 years old who underwent RVOT reconstruction using conduits between 2000 and 2017. Clinical records and imaging data were analyzed.

Results. A total of 400 patients underwent implantation of 495 conduits including glutaraldehyde (GA)-treated bovine jugular vein (contegra) (n = 181); GA-treated xenopericardial conduit (BioLAB) (n = 84); diepoxyde (DE)-treated xenopericardial conduit with porcine aortic root (AB-composite) (n = 65); DE-treated xenopericardial conduit (Pilon) (n = 32) and cryopreserved pulmonary homograft (n = 135). Primary implantation was made in 383 cases (77.3%) and conduit reimplantation was made in 112 cases (22.5%). Median follow-up was 79.9 (42.6; 110.7) months. Redo surgery with conduit replacement was made in 41 (8.5%) cases, of these, 6 (2.1%) conduits were replaced due to thrombosis, endocarditis was diagnosed in 14 patients (4.8%), there were no statistical differences between the groups. Younger age was associated with high risk of early dysfunction (OR 0.97; 95% CI 0.96–0.99, p = 0.03). Multivariate analysis revealed that the type of conduit was not a risk factor (OR 0,86; 95% CI 0,64–1,15; p = 0,64). Severe calcification was the main predictor of conduit-associated mortality (OR 0.02; 95% CI 0.002–0.34; p = 0.005).

Conclusion. Incidence of reintervention due to conduit dysfunction is still high in pediatric group and is not associated with type of conduit. All types of available conduits showed comparable rates of dysfunction. Risk of developing conduit-associated infective endocarditis also does not depend on the type of implanted graft.

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