초록접수 현황
| 17F-166 | 구연 발표 |
Search for the Ideal Conduit: Our Experience with Homemade Expanded Polytetrafluoroethylene Valved Conduit
Eung Re Kim, Jae Hong Lim, Jooncheol Min, Jae Gun Kwak, Woong-Han Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Purpose : A wide range of congenital heart diseases require right ventricular outflow tract reconstruction (RVOTR) with valved conduits. The ideal choice for a valved conduit, however, has yet to be found. Since 2008, we have implanted homemade tri-leaflet conduits made of expanded polytetrafluoroethylene (ePTFE). This report assesses our experience with these prostheses.
Methods : From 2008 to 2016, 77 homemade ePTFE valved conduits were implanted in 68 patients. The mean age at operation was 4.4±4.16 years (range 19 days to 14 years) with a mean body weight of 16.7±13.36kg. Mean conduit size was 16.1±3.38mm with a pulmonary annulus z-score of 1.07±1.04. Excluding 2 foreign patients, 66 patients (97.1%) were followed up during a mean period of 2.91±2.39 years.
Results : Seven out of 77 conduits (10.4%) required reoperation for conduit stenosis at 3.4±1.56 years after implantation. Overall freedom from reoperation and re-intervention at 5 years was 75% and 46%, respectively. Patients with smaller conduit size, younger age and lower bodyweight at operation were predisposed to re-intervention. In small patients (≤10kg), larger conduits with a pulmonary annulus z-score bigger than 1.5 showed no superiority compared to smaller ones (p=0.9156). However, in bigger patients (10~30kg), larger conduits tended to require fewer re-intervention and last longer (p=0.0348).
Conclusion : Homemade ePTFE valved conduits can provide a good alternative for RVOT reconstruction especially in small in children. Implanting an oversized conduit in small children (≤10kg) showed no benefit. Longer follow-up is needed to determine how the larger ePTFE conduits will fare compared to commercialized prosthetic valves.
Methods : From 2008 to 2016, 77 homemade ePTFE valved conduits were implanted in 68 patients. The mean age at operation was 4.4±4.16 years (range 19 days to 14 years) with a mean body weight of 16.7±13.36kg. Mean conduit size was 16.1±3.38mm with a pulmonary annulus z-score of 1.07±1.04. Excluding 2 foreign patients, 66 patients (97.1%) were followed up during a mean period of 2.91±2.39 years.
Results : Seven out of 77 conduits (10.4%) required reoperation for conduit stenosis at 3.4±1.56 years after implantation. Overall freedom from reoperation and re-intervention at 5 years was 75% and 46%, respectively. Patients with smaller conduit size, younger age and lower bodyweight at operation were predisposed to re-intervention. In small patients (≤10kg), larger conduits with a pulmonary annulus z-score bigger than 1.5 showed no superiority compared to smaller ones (p=0.9156). However, in bigger patients (10~30kg), larger conduits tended to require fewer re-intervention and last longer (p=0.0348).
Conclusion : Homemade ePTFE valved conduits can provide a good alternative for RVOT reconstruction especially in small in children. Implanting an oversized conduit in small children (≤10kg) showed no benefit. Longer follow-up is needed to determine how the larger ePTFE conduits will fare compared to commercialized prosthetic valves.
첨부파일 : 17F-166.pptx
책임저자: Woong-Han Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
발표자: Eung Re Kim, E-mail : xion119@naver.com