Left ventricle-aortic conduits in pediatric patients

Abstract

From August, 1974, to January, 1982, left ventricle-aortic porcine valved conduits were inserted in three patients less than 2 years old (Group 1) and in 10 patients between 2 and 14 years of age (Group 2) for relief of severe left ventricular outflow tract obstruction. The distal anastomosis was made to the ascending aorta in seven patients and to the supraceliac abdominal aorta in six patients. In six patients, the conduit was sutured directly to the left ventricle, and in seven a stented right-angle connector was employed. The left ventricle-aortic gradients were relieved in all cases (mean residual gradient = 4.3 mm Hg). All three patients in Group 1 had associated endocardial fibroelastosis and all died. There was one early death in Group 2 (10% mortality). Reoperation was required in seven of nine survivors (78%) 2.7 to 5.2 years postoperatively for conduit valve failure (five patients), progression of mild native aortic valve insufficiency (one patient), or both (one patient). One of the seven required another reoperation for re-replacement of the conduit valve. There was one late death associated with reoperation. At follow-up 3.4 to 7.5 years postoperatively, four patients are in Functional Class I, two are in Class II, and two are convalescing from reoperation. Left ventricle-aortic conduits provide excellent relief of left ventricular outflow tract obstruction. However, the high incidence of late complications suggests better results might be anticipated with aortoventriculoplasty (Konno).