Abstract
Objective: the aim of this study was to analyze the results of reoperations on right ventricle (RV) – pulmonary artery (PA) conduit (artificial pulmonary trunk).
Material and methods. Between 1986 and 2018, 104 patients underwent surgical reoperations on artificial pulmonary trunk which was implanted during coronary heart diseases (CHD) correction. Age at CHD correction was 3.5±2.5 years, the interval between CHD correction and reoperation on conduit was 9.8±5.5 years. Total conduit replacement with valved (n=9) or non-valved (n=6) conduit was performed in 15 (14.4%) patients. Conduit reconstruction was performed in 88 (84.6%) patients: enlargement of the RV-PA conduit with preservation of the posterior and sides of the conduit wall by xenopericardial patch with monocusp (valved reconstruction, n=31), and by synthetic or xenopericardial patch without monocusp (non-valved reconstruction, n=57). In 1 (1%) patient, the second RV–PA conduit was implanted.
Results. Hospital mortality was 10.6% (n=11). The cause of death was intraoperative heart injury in 10 patients, and sepsis in 1 patient. The systolic pressure in the RV decreased from 115.7±30.9 mm Hg before reoperation to 51.4±14.0 mm Hg after reoperation and the RV–PA systolic pressure gradient decreased from 91.3±31.2 mm Hg before reoperation to 25.6±10.6 mm Hg after reoperation. Mean follow-up was 5.3±3.8 years (1.1–27 years). Reoperation was required in 17 patients with conduit dysfunction. Overall freedom from reoperation for conduit dysfunction at 5, 8, and 15 years was 96, 76 and 61%, respectively. Freedom from reoperations at 10 and 15 years was higher in patients with conduit reimplantation (90 and 68%, respectively), than in patients with conduit reconstruction (62 and 60%, respectively). The freedom from reoperations was higher in patients with reimplantation of non-valved conduit or with non-valved reconstruction, than in patients with reimplantation of valved conduit or with conduit reconstruction by xenopericardial patch with monocusp valve – 100, 88 and 88% vs. 87, 32 and 30% at 5, 10 and 15 years, respectively.
Conclusion. Reimplantation of a non-valved conduit or non-valved reconstruction of a conduit is characterized by a longer period of the freedom from reoperations and transcatheter interventions. Patients with pulmonary hypertension, RV dysfunction, hypoplasia of the PA system require valved conduit reimplantation or conduit reconstruction using a patch with monocusp.
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About the authors
- Vladimir P. Podzolkov, Dr. Med. Sc., Professor, Academician of RAS, Head of Department, orcid.org/0000-0002-2863-2072
- Mikhail R. Chiaureli, Dr. Med. Sc., Professor, Chief Researcher, orcid.org/0000-0002-6456-9269
- Timur Yu. Danilov, Dr. Med. Sc., Leading Researcher, orcid.org/0000-0002-9409-3230
- Viktor B. Samsonov, Dr. Med. Sc., Leading Researcher, orcid.org/0000-0002-6477-7914
- Vladimir N. Cheban, Dr. Med. Sc., Leading Researcher, orcid.org/0000-0002-4608-7661
- Dmitriy V. Kovalev, Dr. Med. Sc., Leading Researcher, orcid.org/0000-0002-4586-9258
- Tat'yana O. Astrakhantseva, Dr. Med. Sc., Leading Researcher, orcid.org/0000-0002-8393-0275
- Bokhodir N. Sabirov, Dr. Med. Sc., Chief Researcher, orcid.org/0000-0001-8577-2162
- Inga V. Zemlyanskaya, Dr. Med. Sc., Leading Researcher, orcid.org/0000-0002-8528-3710
- Asan P. Zhumanov, Cardiovascular Surgeon, orcid.org/0000-0001-9850-1687
- Khushnud Sh. Nizamov, Postgraduate, orcid.org/0000-0002-7656-3278
