Mid-term follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure☆

Ochiai, Yoshie; Imoto, Yutaka; Sakamoto, Masato; Kajiwara, Takashi; Sese, Akira; Watanabe, Mamie; Ohno, Takuro; Joo, Kunitaka

doi:10.1016/j.ejcts.2009.02.013

Cited by 33 publications

(22 citation statements)

References 22 publications

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“…The EC group exhibited decreases in normalized FP minimum and mean diameters, which was expected due to the differing material compositions of the two pathways. This is further supported by the greater variation observed in the absolute mean diameter for the FP in the LT compared to the EC (independent of age or BSA), which is consistent with the literature[25, 30]. …”

Section: Commentsupporting

confidence: 90%

Fontan Pathway Growth: A Quantitative Evaluation of Lateral Tunnel and Extracardiac Cavopulmonary Connections Using Serial Cardiac Magnetic Resonance

Restrepo

Mirabella

Tang

et al. 2014

The Annals of Thoracic Surgery

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Background Typically, a Fontan connection is constructed as either a lateral tunnel (LT) pathway or an extracardiac (EC) conduit. The LT is formed partially by atrial wall and is assumed to have growth potential, but the extent and nature of LT pathway growth have not been well characterized. A quantitative analysis was performed to evaluate this issue. Methods Retrospective serial cardiac magnetic resonance data were obtained for 16 LT and 9 EC patients at two time points (mean time between studies 4.2±1.6 years). Patient-specific anatomies and flows were reconstructed. Geometrical parameters of Fontan pathway vessels and the descending aorta were quantified, normalized to body surface area (BSA), and compared between time points and Fontan pathway types. Results Absolute LT pathway mean diameters increased over time for all but 2 patients; EC pathway size did not change (2.4 ± 2.2 mm versus 0.02 ± 2.1 mm, p <0.05). Normalized LT and EC diameters decreased, while the size of the descending aorta increased proportionally to BSA. Growth of other cavopulmonary vessels varied. The patterns and extent of LT pathway growth were heterogeneous. Absolute flows for all vessels analyzed, except for the superior vena cava, proportionally to BSA. Conclusions Fontan pathway vessel diameter changes over time were not proportional to somatic growth but increases in pathway flows were; LT pathway diameter changes were highly variable. These factors may impact Fontan pathway resistance and hemodynamic efficiency. These findings provide further understanding of the different characteristics of LT and EC Fontan connections and set the stage for further investigation.

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Section: Commentsupporting

confidence: 90%

Fontan Pathway Growth: A Quantitative Evaluation of Lateral Tunnel and Extracardiac Cavopulmonary Connections Using Serial Cardiac Magnetic Resonance

Restrepo

Mirabella

Tang

et al. 2014

The Annals of Thoracic Surgery

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“…Osteoconductive scaffolds [53], metallic anchors for soft tissues [20], predetermined suture sites embedded in the metallic prostheses [50], and coating of the prostheses with novel materials [14,16,45], have been described to promote soft tissue ingrowth and improve function after limb salvage with endoprostheses. All of the surgical options for proximal humerus reconstruction have been associated with instability [25], recurrent dislocation [25,38], and overall poor function [36,38]. In the present study, the authors describe the surgical technique using an aortograft during humerus reconstructions, the functional level and shoulder ROM of patients undergoing the procedure, and the incidence of postoperative dislocation and shoulder instability.…”

Section: Discussionmentioning

confidence: 95%

“…As the humeral insertions for the rotator cuff complex and deltoid muscle are often involved in the resection, all of these techniques have stressed the importance of conserving a sufficient soft tissue envelope for reconstruction and the need to recreate sites for attachment of remaining structures. We supplemented these approaches with a synthetic mesh (Gore Graft; Gore Medical, Flagstaff, AZ) commonly used in cardiovascular procedures [10,12,38,39,49]. The ''aortograft'' is a flexible, self-expanding tube of polytetrafluoroethylene (ePTFE) used for the treatment of aortic aneurysms.…”

Section: Methodsmentioning

confidence: 99%

Proximal and Total Humerus Reconstruction With the Use of an Aortograft Mesh

Marulanda

Henderson

Cheong

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The shoulder is commonly affected by primary and metastatic tumors. Current surgical techniques for complex shoulder reconstruction frequently result in functional deficits and instability. A synthetic mesh used in vascular surgery has the biological properties to provide mechanical constraint and improve stability after tumor related shoulder reconstruction. Questions/purposes We describe (1) surgical technique using a synthetic mesh during humerus reconstructions; (2) functional level defined as shoulder ROM of patients undergoing the procedure; (3) incidence of postoperative dislocation and shoulder instability; and (4) complications associated with the use of the device. Methods We retrospectively reviewed 16 patients with proximal humerus replacements reconstructed with a synthetic mesh from February 2006 to July 2008. Patients were followed clinically and radiographically for a minimum of 13 months (mean, 26 months; range, 13-43 months).Results There were no shoulder dislocations at the latest followup. The mean shoulder flexion was 43°(range, 15°-170°) and mean shoulder abduction of 38 (range, 15°-110°). The mean operative time was 121 minutes (range, 80-170 minutes) and the mean blood loss was 220 mL (range, 50-750 mL).

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“…14,15 While synthetic vascular prostheses such as expanded polytetrafluoroethylene (ePTFE) and Dacron are available alternatives for high-flow, low-resistance, large peripheral vessel pathologies, their clinical outcome for small-diameter ( < 6 mm) vessel replacement has been grim. [16][17][18][19][20] Prosthetic graft failure has been attributed to intimal hyperplasia, thrombogenicity, compliance mismatch, and diameter mismatch between the graft and native artery. [21][22][23][24] Despite decades of effort, the successful fabrication of an ideal vascular graft still remains a challenge.…”

Section: Vascular Tissue Engineering: Unmet Clinical Needmentioning

confidence: 99%