20-Years Expirience with Pulmonary Allograft in Pediatric Heart Surgery: Diferent Techniques and Results

Sergej S. Volkov, Mikhail A. Zelenikin, Mikhail M. Zelenikin, Dmitrij V. Britikov, Ivan T. Narmani

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.26 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objective: the purpose of this study was to describe different surgical techniques of right ventricle (RV) to pulmonary arteries (PAs) connection using a cryopreserved decellularized pulmonary allograft in children and to assess the results.

Methods: in the period from 1994 till 2017, 46 young children with complex congenital heart defects have undergone an open-heart surgery with RV-PAs reconstruction using pulmonary allograft. Mean age was 4,3 years. Depending on situation, pulmonary allografts were cut out in different ways according different techniques: 1) RV-PAs bypass reconstruction (n=8), 2) orthotopic pulmonary valve implantation (n=26); 3)RV-PAs reconstruction with conduit size reduction (bicuspidalisation) (n=12); transannular patch reconstruction with monocuspid valve (n=12). An immediate quality of surgical technique was scored as optimal, adequate and inadequate by Boston Technical Performance Score using transthoracic echocardiography. Also studied were intermediate results during a five-year period.

Results: 30-day mortality was zero. The immediate and intermediate quality of surgical technique was optimal (n=42, 91,3%; n=33, 71,6% ) or adequate (n=4, 8,7%; n=7, 15,9% ) respectively. There were no late deaths. The freedom from redo-surgery after 1, 5 and 10 years was 97,8%, 91,3% and 89% respectively.

Conclusion: pulmonary allograft is a useful option for different reconstructive techniques in congenital heart surgery for young children, providing good early and intermediate results, however late outcomes in this age group are still not defined and require further study.