Impact of a Composite Valved RV-PA Graft After Stage 1 Palliation

Abstract

The use of an interposition femoral vein homograft into the RVPAS may enhance perioperative stability, but it does not substantially improve interstage growth of the pulmonary arteries. Use of saphenous vein homograft is associated with earlier time to reintervention after S1P.

Aortic or Pulmonary Valved Homograft Right Ventricle to Pulmonary Artery Conduit in the Norwood Procedure

“…In a recent report using a different type of valved conduit, the group from Boston has, for the first time, reported an early postoperative advantage of valved over nonvalved RVPAC, as measured by arterial saturation and lactate levels in the first 72 hours. 4 The obvious valve choice for us was the cryopreserved aortic or pulmonary homograft, whenever there was one available. There is no need to use a valve of smaller than approximately 10 mm diameter, since the PTFE part of the conduit provides the restriction in the circuit.…”

“…From a technical standpoint, aortic and pulmonary valves are easy to use due to their short valve cusp height, as opposed to femoral and saphenous vein homografts, which recently have been reexplored by other groups, 4,5 after the initial report from 2002. 8 When evaluating the need for percutaneous intervention, typically for pre-Glenn desaturation, our rate was slightly higher among valved RVPAC patients than in our small nonvalved conduit group, albeit not significantly so.…”

“…The reintervention rate of 29% still compares favorably to rates in the abovementioned reports using femoral vein homograft. 4,5 For completeness sake, we will mention another recent report from Spain using a stentless bovine valved conduit with good results. 6 We are a little concerned about the technical aspects of anastomosing this rather stiff conduit, but one must appreciate the fact that it is available off-the-shelf and does not carry the risk of HLA sensitization.…”

“…In a recent report using a different type of valved conduit, the group from Boston has, for the first time, reported an early postoperative advantage of valved over nonvalved RVPAC, as measured by arterial saturation and lactate levels in the first 72 hours. 4…”

“…Recently, there have been additional reports of results using different valved modifications of RVPAC, using other materials. [4][5][6]…”