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| Can Pulmonary Conduit Dysfunction and Failure Be Reduced In Infants Less Than Age Two Years?: A Congenital Heart Surgeons Society Study |
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Back to 86th Annual Meeting Back to Program Outline Objectives: We sought to examine risk-factors for pulmonary conduit (PC) failure or important PC stenosis or regurgitation on echo in infants < age 2 years at initial implant. Methods: From 2002 - 2005, 218 patients at 17 Congenital Heart Surgeon's Society member institutions were discharged alive after initial PC insertion. Initial PC type was pulmonary allograft in 37%, aortic allograft 31%, bovine jugular venous valved conduit (JVV) in 25%, porcine heterograft 3%, and decellularized allograft in 3%. Median age was 2 months at initial PC insertion. Parametric hazard analysis determined the time-related prevalence and associated risk factors for conduit reoperation (CR) and percutaneous intervention following initial PC implant. Serial echo measurements (n=564) collected at a median interval of 6 months (1 day - 3.2 years) following initial implant were analyzed using mixed linear regression models. Results: 218 children had 248 PCs implanted and 98 post-implant percutaneous interventions. Median age was 8 months at first percutaneous intervention and 1.4 years at CR. Survival at 5 years from initial PC was 97%, and freedom from any reintervention (percutaneous or surgical) at 3 years was 43%. At 4 years, 38% of children underwent CR and 17% had percutaneous intervention. Risk-factors for CR included smaller prosthesis Z-score (P=0.002), absence of a proximal noncircumferential hood (P=0.02), and the use of an aortic allograft (P=0.04). Risk-factors for percutaneous intervention included use of an aortic allograft (P=0.004), proximal extension with autologous pericardium (P=0.002), and smaller prosthesis Z-score (P=0.06). The prevalence of PC stenosis was increased by smaller prosthesis Z-score, aortic allografts, and proximal extension with autologous pericardium (Figure). Conduit regurgitation was accelerated in those with noncircumferential extension or JVV. Conclusions: PC failure and dysfunction are frequent in patients < age 2 years at initial implant. The predominant mode of PC dysfunction is dependent on PC type. Smaller prosthesis Z-score increases PC reintervention and PC stenosis. Aortic allografts have increased reintervention rates and a higher prevalence of PC stenosis compared to other PC types. PC longevity in infants can therefore be improved by using larger prostheses, avoiding aortic allografts, and using noncircumferential extension hoods not made of autologous pericardium. 
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