par Bové, Thierry;Demanet, Hélène ;Beyens, Thierry;Viart, Pierre ;Dessy, Hugues ;Deville, Andrée;Goldstein, Jacques ;Deuvaert, Frank
Référence The annals of thoracic surgery, 62, 5, page (1347-1350)
Publication Publié, 1996-11
Article révisé par les pairs
Résumé : Background. In contrast to the wide and successful use of valved aortic and pulmonary homografts, the nonvalved prolongation of the thoracic aorta for the repair of some complex congenital heart diseases has rarely been described. We present here our experience with the use of descending aorta and aortic arch homografts as nonvalved conduits for the surgical repair of complex cardiac malformations in 8 patients. Methods. One atriopulmonary conduit replacement, four extraatrial cavopulmonary connections, and one intraatrial cavopulmonary repair were achieved by means of a homograft of the descending aorta with a diameter of 15 to 17 mm. Three pulmonary unifocalization procedures were carried out in 2 more patients using a curved homograft of the aortic arch with a diameter of 18 mm. Except for 1 patient, whose incompetent common atrioventricular valve was replaced with a mechanical prosthesis, all other patients were managed without anticoagulation. Results. No conduit-related complications were seen during a follow-up of 18 to 42 months. One patient died perioperatively during an emergency central repair of the right ventricular outflow tract after bilateral unifocalization with arch homografts. Another patient died suddenly 4 months after cavopulmonary connection. The remaining 6 patients are currently doing well. Conclusions. Regardless of the complexity of the underlying malformations, we are encouraged to use nonvalved thoracic aortic homografts in the repair of congenital cardiac diseases because of the reduction in thrombotic, hemorrhagic, and infectious complications associated with their use; convenience in handling; and their versatility in size and shape.

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