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Beqaj H, Goldshtrom N, Linder A, Buratto E, Setton M, DiLorenzo M, Goldstone A, Barry O, Shah A, Krishnamurthy G, Bacha E, Kalfa D. Valved Sano conduit improves immediate outcomes following Norwood operation compared with nonvalved Sano conduit. J Thorac Cardiovasc Surg 2024; 167:1404-1413. [PMID: 37666412 DOI: 10.1016/j.jtcvs.2023.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/27/2023] [Accepted: 08/12/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Use of a valved Sano during the Norwood procedure has been reported previously, but its impact on clinical outcomes needs to be further elucidated. We assessed the impact of the valved Sano compared with the nonvalved Sano after the Norwood procedure in patients with hypoplastic left heart syndrome. METHODS We retrospectively reviewed 25 consecutive neonates with hypoplastic left heart syndrome who underwent a Norwood procedure with a valved Sano conduit using a femoral venous homograft and 25 consecutive neonates with hypoplastic left heart syndrome who underwent a Norwood procedure with a nonvalved Sano conduit between 2013 and 2022. Primary outcomes were end-organ function postoperatively and ventricular function over time. Secondary outcomes were cardiac events, all-cause mortality, and Sano and pulmonary artery reinterventions at discharge, interstage, and pre-Glenn time points. RESULTS Postoperatively, the valved Sano group had significantly lower peak and postoperative day 1 lactate levels (P = .033 and P = .025, respectively), shorter time to diuresis (P = .043), and shorter time to enteral feeds (P = .038). The valved Sano group had significantly fewer pulmonary artery reinterventions until the Glenn operation (n = 1 vs 8; P = .044). The valved Sano group showed significant improvement in ventricular function from the immediate postoperative period to discharge (P < .001). From preoperative to pre-Glenn time points, analysis of ventricular function showed sustained ventricular function within the valved Sano group, but a significant reduction of ventricular function in the nonvalved Sano group (P = .003). Pre-Glenn echocardiograms showed competent conduit valves in two-thirds of the valved Sano group (n = 16; 67%). CONCLUSIONS The valved Sano is associated with improved multi-organ recovery postoperatively, better ventricular function recovery, and fewer pulmonary artery reinterventions until the Glenn procedure.
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Affiliation(s)
- Halil Beqaj
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Nimrod Goldshtrom
- Division of Neonatalogy, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Alexandra Linder
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Edward Buratto
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Matan Setton
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Michael DiLorenzo
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Andrew Goldstone
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Oliver Barry
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Amee Shah
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Ganga Krishnamurthy
- Division of Neonatalogy, Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Emile Bacha
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - David Kalfa
- Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.
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Huyan Y, Chang Y, Song J. Application of Homograft Valved Conduit in Cardiac Surgery. Front Cardiovasc Med 2021; 8:740871. [PMID: 34712711 PMCID: PMC8545902 DOI: 10.3389/fcvm.2021.740871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Valved conduits often correct the blood flow of congenital heart disease by connecting the right ventricle to the pulmonary artery (RV-PA). The homograft valved conduit was invented in the 1960s, but its wide application is limited due to the lack of effective sterilization and preservation methods. Modern cryopreservation prolongs the preservation time of homograft valved conduit, which makes it become the most important treatment at present, and is widely used in Ross and other operations. However, homograft valved conduit has limited biocompatibility and durability and lacks any additional growth capacity. Therefore, decellularized valved conduit has been proposed as an effective improved method, which can reduce immune response and calcification, and has potential growth ability. In addition, as a possible substitute, commercial xenograft valved conduit has certain advantages in clinical application, and tissue engineering artificial valved conduit needs to be further studied.
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Affiliation(s)
- Yige Huyan
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Chang
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangping Song
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Qian T, Yuan H, Chen C, Liu Y, Lu T, Huang C, Wu Z. Conduits for Right Ventricular Outflow Tract Reconstruction in Infants and Young Children. Front Surg 2021; 8:719840. [PMID: 34631780 PMCID: PMC8492946 DOI: 10.3389/fsurg.2021.719840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/11/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose of Review: Right ventricular outflow tract (RVOT) reconstruction remains a challenge due to the lack of an ideal conduit. Data and experience are accumulating with each passing day. Therefore, it is necessary to review this topic from time to time. This is a 2021 update review focused on the history, evolution, and current situation of small-sized conduits (≤ 16 mm) for RVOT reconstruction in infants and young children. Recent Findings: Currently, the available small-sized (≤16 mm) conduits can meet most clinical needs. Homograft is still a reliable choice for infants and young children validated by a half-century clinical experience. As an alternative material, bovine jugular vein conduit (BJVC) has at least comparable durability with that of homograft. The performance of expanded polytetrafluoroethylene (ePTFE) is amazing in RVOT position according to limited published data. The past century has witnessed much progress in the materials for RVOT reconstruction. However, lack of growth potential is the dilemma for small-sized conduits. Tissue-engineering based on cell-free scaffolds is the most promising technology to obtain the ideal conduit. Summary: No conduit has proved to have lifelong durability in RVOT position. We are far from the ideal, but we are not in a state of emergency. In-depth clinical research as well as innovation in material science are needed to help improve the durability of the conduits used in infants and young children.
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Affiliation(s)
- Tao Qian
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Haoyong Yuan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Chunyang Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Yuhong Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Can Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
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Choi PS, Sleeper LA, Lu M, Upchurch P, Baird C, Emani SM. Revisiting prosthesis choice in mitral valve replacement in children: Durable alternatives to traditional bioprostheses. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)31281-2. [PMID: 32713632 DOI: 10.1016/j.jtcvs.2020.04.173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine risk factors for re-replacement and death or transplant following mitral valve replacement (MVR) in children METHODS: This is a retrospective 26-year review of patients younger than 20 years of age undergoing MVR between 1992 and 2018 at single institution. Outcomes included freedom from re-MVR and transplant-free survival. Cox proportional hazards regression models assessed association between outcomes and potential risk factors. RESULTS At median age 4.2 years, 190 children underwent 290 MVR: 180 mechanical, 63 porcine, 13 pericardial, and 34 stented bovine jugular vein valves. Re-MVR occurred in 100 valves. Freedom from re-MVR at 5 and 10 years was 76% and 44%. Times to re-MVR were associated with prosthesis type (P < .001), with porcine and pericardial valves at greatest risk. Other risk factors for prosthetic failure included smaller prosthesis size and left ventricular hypoplasia. There were 9 transplants and 44 deaths. Transplant-free survival at 5 and 10 years was 81% and 76%. Prosthesis type was significantly associated with time to death/transplant in univariate analysis only (P = .021), with porcine at greater risk than mechanical. Independent risk factors for death/transplant included larger indexed geometric orifice area and longer bypass time. CONCLUSIONS In pediatric patients undergoing MVR, mechanical and stented bovine jugular vein valves were associated with increased durability compared with fixed-diameter bioprosthetic alternatives.
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Affiliation(s)
- Perry S Choi
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, , Boston, Mass
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Patrick Upchurch
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Md
| | - Christopher Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, , Boston, Mass
| | - Sitaram M Emani
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, , Boston, Mass.
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Lauk-Dubitskiy SE, Pushkarev AV, Korovin IA, Shakurov AV, Burkov IA, Severgina LO, Zherdev AA, Tsiganov DI, Novikov IA. Porcine heart valve, aorta and trachea cryopreservation and thawing using polydimethylsiloxane. Cryobiology 2020; 93:91-101. [DOI: 10.1016/j.cryobiol.2020.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 12/12/2022]
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Bichell D. Composite polytetrafluoroethylene homograft with external stent as valved pulmonary conduit: All hat and no cattle? J Thorac Cardiovasc Surg 2018; 157:351-352. [PMID: 30557951 DOI: 10.1016/j.jtcvs.2018.09.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- David Bichell
- Department of Cardiac Surgery, Monroe Carell, Jr Children's Hospital, Vanderbilt University Medical Center, Nashville, Tenn.
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