Use of Right Ventricular Remodeling Surgery with a Porcine Pulmonary Prosthesis for Congenital Heart Disease

Authors

  • Miguel A. Maluf
  • Antonio C. C. Carvalho
  • Werther B. Carvalho

DOI:

https://doi.org/10.1532/HSF98.20101041

Abstract

Background: The reconstruction of the right ventricular outflow tract (RVOT) in congenital heart disease has attracted the interest of cardiac surgeons determined to alleviate the anatomic obstruction and restore RV function.

Methods: From June 1991 to September 2008, 203 consecutive patients (mean, 3.0 years; range, 2 months to 35 years) underwent operations. These patients were classified into 5 groups: group 1, tetralogy of Fallot with pulmonary hypoplasia (144 cases, 70.9%); group 2, pulmonary atresia (PA) with ventricular septal defect (VSD) (32 cases, 15.7%); group 3, truncus arteriosus (12 cases, 5.9%); group 4, transposition of the great arteries with left ventricular outflow tract obstructions (8 cases, 3.9%); and group 5, PA with intact ventricular septum (7 cases, 3.4%). Remodeling surgery of the RV consisted of patch closure of the VSD (n = 176), tricuspid valvoplasty repair (n = 25), infundibulum muscle resection, and reconstruction of the RVOT (all patients). The Lecompte procedure was performed in 8 patients in group 4, and the one and a half ventricle technique was performed in 7 patients in group 5.

Results: There were 21 hospital deaths (10.3%); 180 patients (88.6%) survived. Patients were followed up from 4 to 206 months (mean, 98.0 months). Sixteen patients (8.8%) underwent reoperation for prosthesis dysfunction, with 2 inhospital deaths (12.5%). The rest of the patients (164, 80.7%) remain free of reoperation.

Conclusion: Earlier reconstruction of the pulmonary valve and the RVOT may preserve ventricular performance for a long period. Nevertheless, the porcine pulmonary prosthesis has shown satisfactory results when it has been used for the reconstruction of different types of RV obstructions.

References

Albert JD, Bishop DA, Fullerton DA, Campbell DN, Clarke DR. 1993. Conduit reconstruction of the right ventricle outflow tract. Lessons learned in a twenty-year experience. J Thorac Cardiovasc Surg 106:228-35.nBando K, Danielson GK, Schaff HV, Mair DD, Julsrud PR, Puga FJ. 1995. Outcome of pulmonary and aortic homografts for right ventricular outflow tract reconstruction. J Thorac Cardiovasc Surg 109:509-17.nBarbero-Marcial ML, Riso A, Verginelli G, et al. 1989. Técnica para correção do truncus arteriosus I, II sem conduto extracardíaco. Rev Bras Cir Cardiovasc 4:1-8.nBoudjemline Y, Bonnet D, Agnoletti G, Vouhé P. 2003. Aneurysm of the right ventricular outflow following bovine valved venous conduit insertion. Eur J Cardiothorac Surg 23:122-4.nBové T, Demanet H, Wauthy P, et al. 2002. Early results of valved bovine jugular vein conduit versus bicuspid homograft for right ventricular outflow tract reconstruction. Ann Thorac Surg 74:536-41.nBricker JT. 1995. Sudden death and tetralogy of Fallot. Risks, markers, and causes. Circulation 92:158-9.nBrown JW, Ruzmetov M, Rodefeld MD, Vijay P, Darragh RK. 2006. Valved bovine jugular vein conduits for right ventricular outflow tract reconstruction in children: an attractive alternative to pulmonary homograft. Ann Thorac Surg 82:909-16.nBrown JW, Ruzmetov M, Rodefeld MD, Vijay P, Turrentine MW. 2005. Right ventricular outflow tract reconstruction with an allograft conduit in non-Ross patients: risk factors for allograft dysfunction and failure. Ann Thorac Surg 80:655-64.nBull C, Macartney FJ, Horvath P, et al. 1987. Evolution of long-term results of homograft and heterograft valves in extracardiac conduits. J Thorac Cardiovasc Surg 94:12-9.nCarvalho JS, Shinebourne EA, Busst C, Rigby ML, Redington AN. 1992. Exercise capacity after complete repair of tetralogy of Fallot: deleterious effects of residual pulmonary regurgitation. Br Heart J 67:470-3.nCohen M, Lillehei CW, Varco RL, Warden HE. 1956. Complete anatomical correction of the tetralogy of Fallot defects: report of successful surgical case. AMA Arch Surg 73:526-31.nDavlouros PA, Kilner PJ, Hornung TS, et al. 2002. Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging: detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction. J Am Coll Cardiol 40:2044-52.nEguchi S, Asano K. 1968. Homograft of pulmonary artery or ascending aorta with valve as a right ventricular outflow. J Thorac Cardiovasc Surg 56:413-20.nEguchi S, Irisawa T, Asano K. 1972. Use of valve-retaining homograft and heterograft patch for reconstruction of right ventricular outflow tract. Ann Thorac Surg 14:615-25.nGraham TP Jr, Cordell D, Atwood GF, et al. 1976. Right ventricular volume characteristics before and after palliative and reparative operation in tetralogy of Fallot. Circulation 54:417-23.nHarrison DA, Harris L, Siu SC, et al. 1997. Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot. J Am Coll Cardiol 30:1368-73.nHawkins JA, Bailey WW, Dillon T, Schwartz DC. 1992. Midterm results with cryopreserved allograft valved conduits from the right ventricle to the pulmonary arteries. J Thorac Cardiovasc Surg 104:910-6.nHazekamp MG, Kurvers MM, Schoof PH, et al. 2001. Pulmonary valve insertion late after repair of Fallot's tetralogy. Eur J Cardiothorac Surg 19:667-70.nIlbawi MN, Idriss FS, DeLeon SY, et al. 1987. Factors that exaggerate the deleterious effects of pulmonary insufficiency on the right ventricle after tetralogy repair. Surgical implications. J Thorac Cardiovasc Surg 93:36-44.nIlbawi MN, Lockhart CG, Idriss FS, et al. 1987. Experience with St. Jude Medical valve prosthesis in children. A word of caution regarding right-sided placement. J Thorac Cardiovasc Surg 93:73-9.nKirklin JW, Barrat-Boyes BG. 2003. Cardiac surgery. 3rd ed. New York: Churchill Livingstone.nKiyota Y, Shiroyama T, Akamatsu T, Yokota Y, Ban T. 1992. In vitro closing behavior of the St. Jude Medical heart valve in the pulmonary position. Valve incompetence originating in the prosthesis itself. J Thorac Cardiovasc Surg 104:779-85.nLecompte Y. 1991. Réparation á l'étage ventriculaire—the REV procedure: technique and clinical results. Cardiol Young 1:63-70.nMaluf MA. 1991. Reconstrução da via de saída do ventrículo direito comprótese bivalvulada ou tubular valvada, pulmonar suína. Estudo experimental em ovinos [PhD thesis]. São Paulo, Brazil: Universidade Federal de São Paulo.nMaluf MA. 2009. Late outcome of right ventricular outflow tract repair using bicuspid pulmonary prosthesis in tetralogy of Fallot surgery repair: case report. Rev Bras J Cardiovasc Surg 24:574-7.nMaluf MA, Braile DM, Silva C, Catani R, Carvalho AC, Buffolo E. 2000. Reconstruction of the pulmonary valve and right ventricular outflow tract with bicuspid prosthesis in tetralogy of Fallot. Ann Thorac Surg 70:1911-7.nMarchand P. 1967. The use of a cusp-bearing homograft patch to the outflow tract and pulmonary artery in Fallot's tetralogy and pulmonary valvular stenosis. Thorax 22:497-509.nMarie PY, Marcon F, Brunotte F, et al. 1992. Right ventricular overload and induced sustained ventricular tachycardia in operatively "repaired" tetralogy of Fallot. Am J Cardiol 69:785-9.nMcGoon DC, Baird DK, Davis GD. 1975. Surgical management of large bronchial collateral arteries with pulmonary stenosis or atresia. Circulation 52:109-18.nMiyamura H, Kanazawa H, Hayashi J, Eguchi S. 1987. Thrombosed St. Jude Medical valve prosthesis in the right side of the heart in patents with tetralogy of Fallot. J Thorac Cardiovasc Surg 94:148-50.nMurphy JG, Gersh BJ, Mair DD, et al. 1993. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 329:593-9.nNakata S, Imai Y, Takanashi Y, et al. 1984. A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart disease with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 88:610-9.nNiwaya K, Knott-Graig CJ, Lane MM, Chandrasekaren K, Overholt ED, Elkins RC. 1999. Cryopreserved homograft valves in the pulmonary position: risk analysis for intermediate-term failure. J Thorac Cardiovasc Surg 117:141-6.nNollest G, Fischlein T, Bouterwek S, Böhmer C, Klinner W, Reichart B. 1997. Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 30:1374-83.nOku H, Shirotani H, Sunakawa A, Yokoyama T. 1986. Postoperative long-term results in total correction of tetralogy of Fallot: hemodynamics and cardiac function. Ann Thorac Surg 41:413-8.nOury JH, Hiro SP, Maxwell JM, Lamberti JS, Duran CM. 1998. The Ross procedure: current registry results. Ann Thorac Surg 66(suppl):S162-5.nOwen AR, Gatzoulis AM. 2000. Tetralogy of Fallot: late outcome after repair and surgical implications. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 3:216-26.nPacifico AD, Kirklin JW, Blackstone EH. 1977. Surgical management of pulmonary stenosis in tetralogy of Fallot. J Thorac Cardiovasc Surg 74:382-95.nQuintessenza JA, Jacobs JP, Morell VO, Giroud JM, Boucek RJ. 2005. Initial experience with a bicuspid polytetrafluoroethylene pulmonary valve in 41 children and adults: a new option for right ventricular outflow tract reconstruction. Ann Thorac Surg 79:924-31.nRastelli GC, McGoon DC, Wallace RB. 1969. Anatomic correction of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis. J Thorac Cardiovasc Surg 58:545-52.nRosti L, Murzi B, Colli AM, Festa P, Redaelli S, Frigiola A. 1998. Pulmonary valve replacement: a role for mechanical prostheses? Ann Thorac Surg 65:889-90.nSievens HH, Storde U, Rohwedder EB, et al. 1993. Superior function of a bicuspid over a monocuspid patch for reconstruction of a hypoplastic pulmonary root in pigs. J Thorac Cardiovasc Surg 105:580-90.nStark J, Bull C, Stajevic M, Jothi M, Elliott M, de Leval M. 1998. Fate of subpulmonary homograft conduits: determinants of late homograft failure. J Thorac Cardiovasc Surg 115:506-14.nTherrien J, Marx GR, Gatzoulis AM. 2002. Late problems in tetralogy of Fallot—recognition, management, and prevention. Cardiol Clin 20:395-404.nTurrentine MW, McCarthy RP, Vijay P, McConnell KW, Brown JW. 2002. PTFE monocusp valve reconstruction of the right ventricular outflow tract. Ann Thorac Surg 73:871-9.nVliegen HW, van Straten A, de Roos A, et al. 2002. Magnetic resonance imaging to assess the hemodynamic effects of pulmonary valve replacement in adults late after repair of tetralogy of Fallot. Circulation 106:1703-7.nVougpatanasin W, Hillis LD, Lange RA. 1996. Prosthetic heart valves. N Engl J Med 335:407-16.nVouhé PR, Tamisier D, Leca F, Ouaknine R, Vernant F, Neveux JY. 1992. Transposition of the great arteries, ventricular septal defect, and pulmonary outflow tract obstruction. Rastelli or Lecompte procedure? J Thorac Cardiovasc Surg 103:428-36.nWells WJ, Arroyo H Jr, Bremner RM, Wood J, Starnes VA. 2002. Homograft conduit failure in infants is not due to somatic outgrowth. J Thorac Cardiovasc Surg 124:88-96.nYamagishi M, Kurosawa H. 1993. Outflow reconstruction of tetralogy of Fallot using a Gore-Tex valve. Ann Thorac Surg 56:1414-6.nZavanella C, Portela F. 2004. Early failure of bovine jugular vein conduit. J Thorac Cardiovasc Surg 127:610.n

Published

2011-02-23

How to Cite

Maluf, M. A., Carvalho, A. C. C., & Carvalho, W. B. (2011). Use of Right Ventricular Remodeling Surgery with a Porcine Pulmonary Prosthesis for Congenital Heart Disease. The Heart Surgery Forum, 14(1), E40-E50. https://doi.org/10.1532/HSF98.20101041

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