RIGHT VENTRICULAR OUTFLOW TRACT RECONSTRUCTION WITH HOMOGRAFT.
CRITICAL REVIEW OF 17 CASES.

A. Saracino°, C. Cavalli°, A. Giamberti*, A. Agnetti°, M. Carminati*, N. Carano°, A. Frigiola*, C. Cicero., B. Tchana, V. Allegri, L. Zavota, U. Squarcia°
°) Cardiologia Pediatrica - Dip. dell'Età Evolutiva - Univ. di Parma
*) Cardiologia e Cardiochirurgia Pediatrica - IPSD - S. Donato Milanese (MI)


Background: we refer of a series of 17 complex CHD (table), operated upon between 1991 and 2001 (age:1m.-37y.o.) for right ventricular outflow tract (RVOT) reconstruction by positioning a homograft conduit (CVH).

Results and Follow-Up Parameters: early (<30dd.) p.o. mortality, early p.o. complications, persisting anatomic defects at discharge, late mortality, onset and progression (DP enhancement =20mmHg between the first and the latest p.o. control) of CVH stenosis, CVH insufficiency, need for reintervention. The follow-up (mean 52mo.±27) was as follows: clinical control, ECG and echocardiography at discharge and q.6-12mo. Diagnostic cardiac catheterization in selected patients according to outcome (5/16, 31.3%). One patient (5.9%) with severe pulmonary valvulopathy and congenital coagulopathy died on day 1 p.o. In 8 other patients (50%) p.o. intensive care complications emerged. At discharge residual RVOT anomalies were present in 3 patients (18%): 1 CVH stenosis (DP=25mmHg)+moderate insufficiency and 2 CVH moderate insufficiency. No late deaths occurred; 4 patients (25%) showed CVH stenosis (DP=50mmHg); progressive stenosis emerged in 7 cases (44%); moderate or severe CVH insufficiency was observed in 9 subjects (56%). Eventually 4 patients in whom CVH was implanted before 17mo. of age needed reintervention during follow-up.

Discussion: a good consistency has been reached regarding the CVH implantation. Our data confirm that CVHs are not the final intervention in most cases, particularly if the CVH is positioned before 2y.o. Important enhancements in this kind of procedures are expected from both interventional catheterization and tissue engeenering for sinthetizing new generation conduits.

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