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Tesi etd-08232015-165713


Thesis type
Tesi di laurea specialistica LC6
Author
DALLIMONTI PERINI, DANIELE
URN
etd-08232015-165713
Title
Right ventricular outflow tract reconstruction using a valved biological conduit (Hancock conduit) late after Tetralogy of Fallot surgical correction
Struttura
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
MEDICINA E CHIRURGIA
Commissione
relatore Dott. Murzi, Bruno
Parole chiave
  • tetralogy
  • Congenital heart disease
  • Fallot
  • tetralogy of Fallot
  • Hancock
  • Dacron valved conduits
  • RVOT
  • porcine valved conduits
  • RVOT reconstruction
  • RV-PA reconstruction
  • conduit
  • valved biological conduits
Data inizio appello
22/09/2015;
Consultabilità
completa
Riassunto analitico
OBJECTIVES: The most appropriate strategy in the management of right ventricular outflow tract (RVOT) reconstruction in patients with tetralogy of Fallot early repair and late failure of right ventricle to pulmonary artery continuity is still debated. This study addresses this issue by evaluating retrospectively 12 years experience in this kind of reconstruction, focusing exclusively on the performance of Hancock conduits.<br><br>METHODS: Data from 32 patients with an early repaired Tetralogy of Fallot, 23 males and 9 females, who underwent 34 RVOT reconstruction (2 were reinterventions) with Hancock conduit at Fondazione Toscana &#34;G. Monasterio&#34; Pediatric Cardiac Surgery department, Massa, Italy between<br>February 2003 and May 2015 were retrospectively reviwed. Median age was 17,6 +/- 11,32 years (range 13 months to 41 years and 8 months), mean BSA 1,4 +/- 0,54m2 (0,34 m2 minimum and 2,12 m2 most), mean height 148,1 +/- 33,6 cm (range 61 cm to 195 cm) and mean weight 49,5 +/- 26,35 Kg (range 6,9 Kg to 96 Kg). The RV-PA peak gradient, RV mean pressure and pulmonary regurgitation were measured before and after the surgical conduit implantation and on follow-up, in addition RV end-diastolic volume index was measured, when feasible, before and after Hancock implantation.<br><br>RESULTS: The early 30 days mortality was 6,25% and not related to conduit failure. Complete follow-up was feasible in 27 patients and the mean duration was 31,6 +/- 34,42 months. The observed RV-PA peak gradient means were 60,4 +/- 30,06 mmHg preoperatively, 29,1 +/- 11,48 mmHg postoperatively and 45,3 +/- 26,02 mmHg on the last follow-up; RV mean pressures were 53,3 +/- 27,73 mmHg preoperatively 41,6 +/- 12,71 mmHg postoperatively and 53,6 +/- 18,8 mmHg on the last follow-up; RV end-diastolic volume index means were 218,3 +/- 57,94 ml/m2 before surgery and 126,1 +/- 14,49 ml/m2 after surgery. Conduit failure was observed in 5 patients in which the the mean freedom from conduit failure was 70,56 +/- 15,02 months (mean age at failure 6,86 +/- 1,78 years), in 4 of them percutaneous intervention were attempted (2 ballooning and 2 melody), 2 successful.<br><br>DISCUSSION: From our series the Hancock conduit can be actually considered as a valuable solution for RVOT reconstruction in already operated patients with ToF, considering good RV pressures and gradients values even after up to 9 years of follow up.
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