Abstract
Objective. Right ventricle outflow tract (RVOT) reconstruction using extracardiac conduits are still one of the urgent problems of surgery
of complex congenital heart defects. Homograft, which many years considered the “gold standard” of RVOT reconstruction, due
to the rapid onset of dysfunction conduits, as well as difficulties in securing conduits of small size, lost their positions. Under the alternative
types of homografts in 1999 appeared a new generation of bovine jugular vein conduits (BJV), which over time have become
increasingly attractive to RVOT reconstruction. The article presents our experience of implantation of BJV conduits in Rastelli operation
for RVOT reconstruction.
Material and methods. Since 2008 to 2015 years 28 patients received 29 bovine jugular vein conduits (14 – male, 14 – female).
Median of Z-score of implanted conduits was 1.36 (0.03–2.4), age's median was 21.5 (12–57) months, average value of body surface
area was 0.50±0.07, median of dynamic observation period was 24 (2–96) months. Diagnosis of transposition of great artery
(including congenitally corrected forms) were in 57% of cases, double outlet of great artery from right ventricle in 21% of cases, atresia
of pulmonary artery in 18% of cases, tetralogy of Fallot in 4 of cases. Distribution of conduits depending on size was follows:
№12 – 4%, № 14 – 21%, № 16 – 61%, № 18 – 7%, № 20 – 7%. Criteria for conduits functional state evaluation was survival rate,
freedom from conduit dysfunction, intervention and reoperation. In all patients was performed Rastelli operation with/not pulmonary
artery ligation (depending on defect's anatomy) with cardiopulmonary bypass, hypothermia and cardioplegia.
Results. In early postoperative period were two conduit unrelated deaths. Using statistical analysis of early results we revealed negative
correlations between Z-score of implanted conduits and time of artificial lungs ventilation and time spent at intensive care unit.
Z-score less than 1.2 was the independent risk factor for complicated by the early postoperative period. In the long-term period
weren't deaths. In this way, actuarial survival was 93.2%. Freedom from conduit dysfunction was after 1, 2 and 5 years was 94.7%,
87.4% и 87.4%, respectively. Freedom from interventions and reoperations was 96.2%.
Conclusion. Our analysis shows good long-term results of right ventricle outflow tract reconstruction using bovine jugular vein conduits
in Rastelli operation, which are similar to the results of other authors. In analysis we found the dependence between early postoperative
period time and Z-score of implanted conduits, as a result we recommend implant conduits with Z-score more than 1.2.
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