Establishing right ventricle-pulmonary artery continuity by autologous tissue: an alternative approach for prosthetic conduit repair Yukihisa Isomatsu,

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Presentation transcript:

Establishing right ventricle-pulmonary artery continuity by autologous tissue: an alternative approach for prosthetic conduit repair Yukihisa Isomatsu, MD, Toshiharu Shin'oka, MD, Mitsuru Aoki, MD, Masatsugu Terada, MD, Takamasa Takeuchi, MD, Shuichi Hoshino, MD, Yoshinori Takanashi, MD, Yasuharu Imai, MD, Hiromi Kurosawa, MD The Annals of Thoracic Surgery Volume 78, Issue 1, Pages 173-180 (July 2004) DOI: 10.1016/j.athoracsur.2003.11.045

Fig 1 Distribution of conduit types used in our institution during four-year intervals between 1982 and 2001. Solid areas = direct anastomosis; grey areas = autologous pericardium; open areas = equine pericardium. The Annals of Thoracic Surgery 2004 78, 173-180DOI: (10.1016/j.athoracsur.2003.11.045)

Fig 2 Direct anastomosis (A, B) and interposition of an autologous pericardial conduit (C). (A) The distal pulmonary arteries were extensively mobilized as far as both hilar regions to expose the origin of the upper lobar branches. The pulmonary artery was brought on the left side of the aorta. An incision in the anterior pulmonary artery was made into the left pulmonary artery in a reversed J shape. A direct anastomosis was performed at the cranial margin of the ventriculotomy incision using several pledgeted mattress sutures. (B) The outflow tract was enlarged by a monocuspid autologous pericardial patch reinforced with Dacron material. (C) After patch angioplasty was completed, if necessary, the autologous pericardial patch was made tubular by approximating its lateral edges, creating an anterior wall long enough to cover the ventricular incision. A single cusp was sutured on its inner anterior wall, and the subvalvular portion was reinforced with Dacron. The Annals of Thoracic Surgery 2004 78, 173-180DOI: (10.1016/j.athoracsur.2003.11.045)

Fig 3 Detailed drawing of the construction of the monocusped autologous pericardial patch. (A) Autologous pericardium is trimmed into semicircular shape (H = 1/2R). (B) Similar figure of semicircle made at (A), at 2/3 the size (R′ = 2/3R, H′ = 2/3H). (C) The cusp width is R′. Cusp height is H′, where H′ is approximately 3/4H′. Thus, this height H′ corresponds to almost one-half of H. Two stay stitches are placed at both lateral ends and a third stitch is placed at the bottom of the cusp. (D) The smooth surface (the serous layer) of the cusp should be oriented to the sinus. The smooth surface of the remaining rectangle pericardium should be the inner surface of the monocuspid patch. The Annals of Thoracic Surgery 2004 78, 173-180DOI: (10.1016/j.athoracsur.2003.11.045)

Fig 4 Kaplan-Meier freedom from late events (conduit replacement or late death) stratified by method. Number of patients at risk in follow-up period stratified by method is shown in parentheses at selected time points. Early mortality is excluded in this analysis. The Annals of Thoracic Surgery 2004 78, 173-180DOI: (10.1016/j.athoracsur.2003.11.045)

Fig 5 Kaplan-Meier patient survival rate stratified by method. Number of patients at risk in follow-up period stratified by method is shown in parentheses at selected time points. There was no significant difference among three groups by log-rank test (p = 0.111). Early mortality is also included in this analysis. The Annals of Thoracic Surgery 2004 78, 173-180DOI: (10.1016/j.athoracsur.2003.11.045)

Fig 6 Preoperative and postoperative right ventricular end-diastolic volume (RVEDV, A) and right ventricular ejection fraction (RVEF, B) grouped by methods. (A) There was no significant change in RVEDV between preoperative and postoperative values in each method (p = 0.605). There was no significant difference in preoperative RVEDV among the three different methods and no significant difference in postoperative RVEDV among the three methods (p = 0.972). (B) There was no significant difference in either the preoperative or postoperative values among the three methods (B, p = 0.646), although there was a significant change in RVEF between preoperative and postoperative values in the method of equine pericardium (B, p = 0.0013). Open bars = preoperative; grey bars = postoperative. The Annals of Thoracic Surgery 2004 78, 173-180DOI: (10.1016/j.athoracsur.2003.11.045)