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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 910-916, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JA Hawkins, WW Bailey, T Dillon and DC Schwartz
From 1985 to 1990, 89 patients underwent placement of 41 aortic and 54
pulmonic cryopreserved allograft valved conduits between the right
ventricle and the pulmonary arteries. Six patients underwent replacement
with a second allograft conduit. Median age at operation was 4.3 years, and
20 patients were infants less than 1 year of age. Conduit sizes averaged 11
mm in the conduits placed in 20 infants and 20 mm in the 75 placed in
patients more than 1 year of age. There were 7 early deaths in 89 patients
(7.8%, 70% confidence levels 5.4% to 11.3%) and 9 late deaths in 82
hospital survivors (11%, 70% confidence levels 8% to 15%). Actuarial
survival was 81% (70% confidence levels 75% to 86%) at 33 months, and no
deaths were due to conduit problems. Late reoperation was required in 13
patients (7 for conduit obstruction, 1 for conduit valve insufficiency, and
5 for nonconduit- related problems). Six of the eight reoperations were
done in patients who had small (< or = 13 mm) conduits placed during
infancy. Conduit failure was similar between pulmonic and aortic
allografts. There were no deaths in the eight patients who required conduit
reoperation. Actuarial freedom from reoperation for conduit dysfunction was
80.5% (70% confidence levels 72% to 86%) at 53 months for the entire group
and 94% (confidence levels 88% to 97%) at 44 months for patients more than
1 year of age. Cryopreserved allograft conduits have good early and midterm
results and are comparable to porcine xenograft conduits. Despite a likely
need for replacement within 3 years, we continue to favor the use in
infants of an allograft valved conduit over a xenograft Dacron conduit. The
need to replace a cryopreserved allograft conduit appears similar for
conduits of aortic or pulmonic origin.
ARTICLES
Midterm results with cryopreserved allograft valved conduits from the right ventricle to the pulmonary arteries
Division of Cardiothoracic Surgery, Children's Hospital Medical Center, Cincinnati, Ohio.
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