23 Right ventricular outflow tract elan conduit: the five year scotland experience

Abstract

Background The management of the right ventricular outflow tract (RVOT) is a common feature in congenital cardiac surgery. A number of valved conduits are available. We reviewed the outcomes of the Vascutek RVOT Elan Conduit in patients from a specialist congenital surgical centre. Methods Between 2010 and 2011, 25 patients (13 male, mean age: 25.5 years) received an Elan conduit in the RVOT position. 24 reported previous open cardiac surgery. Most common diagnosis was Tetralogy of Fallot (n=19 (76%)). Results The mean follow up period was 4.96 years. 24 (96%) patients were alive at the time of censorship. 16 adverse events were noted and defined as haemodynamically significant conduit and/or valve stenosis (n=12), death (n=1) and bacterial endocarditis (n=3). 12 (48%) patients required re-intervention (10 transcatheter pulmonary valve replacements [8 Medtronic Melody and 2 Edwards Sapien] and 2 surgical pulmonary homografts). Mean time to re-intervention 1.7 years (range 0.25 – 4.36 years) Conclusion This review of RVOT Elan conduits demonstrates that in a significant proportion of patients there is short interval to re-intervention due to haemodynamically significant conduit and/or valve stenosis. (Figures 1 and 2) The conduit was technically attractive for transcatheter intervention. Other centres have published favourable results in the first 12 months after surgery. There are no other reported outcomes after this period. Our review suggests that ongoing frequent clinical assessment is required and should continue beyond the first 12 months. The Elan conduit is no longer in production and the search for the ideal valved RVOT conduit continues at a time when homograft availability is becoming an increasing challenge.