Combined Aortic Root and Right Ventricular Outflow Tract Replacement with Mechanical Conduits in Adult Patients after Repeated Surgery for Congenital Heart Disease

Abstract

To manage aortic root aneurysms and right ventricular outflow tract (RVOT) graft dysfunction in adult patients after repeated surgery for congenital heart disease, we performed combined prosthetic aortic root and RVOT replacement. The procedure was performed in 5 patients (2 truncus arteriosus, 2 variants of tetralogy of Fallot, and 1 congenital aortic stenosis), aged 23, 24, 27, 29, and 34 years, who presented with progressive dilation of the aortic root and aortic regurgitation as well as RVOT graft dysfunction. All patients had undergone a median of 3 previous operations and this procedure was their third (in 1), fourth (in 3), or fifth (in 1) operation. The mean interval since the previous operation was 8.2 (3-16) years. Mean cardiopulmonary bypass (CPB) and aortic cross-clamping (AXC) times were 354 (248-422) and 113 (69-142) minutes, respectively. One patient died on the 16th postoperative day from respiratory failure caused by pulmonary bleeding. The other four patients survived the operation and are in New York Heart Association functional class II or less at a maximum of 41 months follow-up. Mechanical valve function in the aortic and pulmonary position is good without any thromboembolic or bleeding complications in all surviving patients. Combined aortic root and RVOT replacement with mechanical conduits in adult patients after repeated surgery for congenital heart disease is a complex operation requiring long CPB time. However, this procedure has the potential to avoid a predictable reoperation associated with conventional biological graft replacement.