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