Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association

Objective: This study aims to analyse the collective experience of participating European Congenital Heart Surgeons Association centres in the surgical management of complications resulting from trans-catheter closure of atrial septal defects (ASDs). Methods: The records of all (n=56) patients, aged 3-70 years (median 18 years), who underwent surgery for complications of trans-catheter ASD closure in 19 participating institutions over a 10-year period (1997-2007) were retrospectively reviewed. Risk factors for surgical complications were sought. Surgical outcomes were compared with those reported for primary surgical ASD closure in the European Association of Cardio-thoracic Surgery Congenital Database. Results: A wide range of ASD sizes (5-34mm) and devices of various types and sizes (range 12-60mm) were involved, including 13 devices less than 20mm. Complications leading to surgery included embolisation (n=29), thrombosis/thrombo-embolism/cerebral ischaemia or stroke (n=12), significant residual shunt (n=12), aortic or atrial perforation or erosion (n=9), haemopericardium with tamponade (n=5), aortic or mitral valve injury (n=2) and endocarditis (n=1). Surgery (39 early emergent and 17 late operations) involved device removal, repair of damaged structures and ASD closure. Late operations were needed 12 days to 8 years (median 3 years) after device implantation. There were three hospital deaths (mortality 5.4%). During the same time period, mortality for all 4453 surgical ASD closures reported in the European Association of Cardio-Thoracic Surgery Congenital Database was 0.36% (p=0.001). Conclusions: Trans-catheter device closure of ASDs, even in cases when small devices are used, can lead to significant complications requiring surgical intervention. Once a complication leading to surgery occurs, mortality is significantly greater than that of primary surgical ASD closure. Major complications can occur late after device placement. Therefore, lifelong follow-up of patients in whom ASDs have been closed by devices is mandator

Durability of homografts used to treat complex aortic valve endocarditis

Acute bacterial endocarditis may be extremely destructive for cardiac valves and their periannular structures. It has been suggested that complex reconstruction procedures require the use of homografts because of their versatility and potency to resist repeated infection.status: publishe

Long-term results with a stentless porcine aortic valve: the Edwards PRIMA model 2500

Background and aim of the study: The study aim was to evaluate the very long-term patient survival, clinical and hemodynamic status after aortic valve replacement (AVR) with the Edwards PRIMA model 2500 stentless porcine aortic valve. Methods: A cohort of 50 patients was prospectively followed between September 1991 and November 2006, with clinical evaluation and echocardiography. The mean patient age at implantation was 72.2 +/- 5.2 years, and the mean valve size 24 mm (range: 19-29 mm). Most patients were in NYHA class II or III before valve implantation. Results: The early mortality was 4% (n = 2). Early morbidity included two revisions for bleeding, and thromboembolic events in four patients. A total of 41 patients died during the follow up period; death was cardiac-related or sudden in 19 patients (40%) and undefined in seven (15%). Prosthetic valve endocardi-tis was diagnosed in five patients, and late thromboembolic events were reported in nine. Bioprosthesis explantation was performed in four patients because of severe structural valve deterioration (SVD). After 10 years, the aortic regurgitation (AR) was grade 1+ or 2+ in 12 of the 17 survivors (71%), and grade >= 3+ in three (18%); at this time the effective orifice area was 1.81 +/- 0.59 cm(2). After 12 years, the aortic regurgitation was grade 1+ or 2+ in two of seven survivors (28%), and grade >= 3+ in four (57%). Survival of the patients did not differ significantly from that of an age-matched Belgian population. Conclusion: Patient survival was comparable with that of an age-matched population after AVR with the Edwards PRIMA model 2500 valve. SVD was mainly characterized by the development of AR

Valved jugular vein segments for right ventricular outflow tract reconstruction in young sheep

OBJECTIVE: This study was undertaken to investigate the degeneration and calcification of valved bovine jugular vein segments for right ventricular outflow tract reconstruction in juvenile sheep. METHODS: Seven valved bovine jugular vein conduits (Contegra model 220; VenPro Corporation, Irvine, Calif) and 3 control conduits (MH100; Medtronic, Inc, Minneapolis, Minn) were implanted in the pulmonary artery in young sheep. After 20 weeks the conduits were explanted and qualitatively analyzed by epicardial echocardiography, gross examination, x-ray analysis, light microscopy, and transmission electron microscopy. Calcification was determined quantitatively by flame atomic absorption spectrometry. RESULTS: Two Contegra conduits could not be analyzed because of endocarditis. All other Contegra conduits functioned well, with preserved structure and minimal calcification. The control MH100 conduits exhibited extensive fibrous sheathing, with calcification of the aortic wall portion and the commissural part of the Hancock valve. CONCLUSIONS: The Contegra conduit's performance was clearly superior to that of the control MH100 conduit when implanted in the pulmonary artery position in juvenile sheep for 5 months.status: publishe

Evolution of the Z-score in size-reduced bicuspid homografts

Human homografts are frequently used to establish an anatomic continuity between the right ventricular outflow tract (RVOT) and the pulmonary artery. Their limited availability, especially in small sizes, has encouraged the use of alternative strategies, such as size-reduced bicuspid homografts. The study aim was to analyze the follow up of patients who had received a standard tricuspid or size-reduced bicuspid homograft in the RVOT position, and to investigate modifications of the patients' Z-scores over the years.status: publishe

Behaviour of polyester grafts in adult patients with repaired coarctation of the aorta

AIMS: Whatever the technique used for surgical or endovascular repair of a coarctation of the aorta (CA), long-term complications might occur. Aneurysm formation after patch angioplasty is not uncommon and may lead to a life-threatening condition. Therefore, we were interested in the long-term results of different types of tube grafts, from which a lower degree of dilatation is expected. METHODS AND RESULTS: All patients, currently older than 16 years, who underwent (redo) surgery for CA, and in whom a tube graft was inserted, were selected from the database of congenital heart disease of our hospital. Follow-up data were collected by reviewing the patients' files. The degree of graft dilatation was calculated for each patient. Fifty-three patients (41 males, median age 33.1 years, Q1-Q3 29.9-40.2 years) could be included in the study, in which 20 (38%) 'Gelseal', 12 (23%) 'Gelsoft', 8 (15%) 'Gelweave', and 13 (24%) older types of grafts were used. Twenty patients underwent a primary repair and in all others a tube graft was implanted after a previous patch angioplasty. The median graft diameter (manufacturer size) at implantation was 20 mm (Q1-Q3 16-22 mm). The median follow-up time of the grafts was 13.1 years (Q1-Q3 9.0-17.2 years). The graft size increased to a median value of 26 mm (Q1-Q3 22-30 mm) (median 50% increase in diameter, range 0-271%, P < 0.0001). The diameter of six grafts remained unchanged during follow-up. Three deaths occurred, of whom two were cardiac-related. False aneurysms occurred in four patients, graft aneurysm in two, endarteritis in two, and graft stenosis in one. CONCLUSION: Nearly, all tube grafts dilated up to 50% of the manufacturer diameter during follow-up. Re-interventions were inevitable in more than 10 per cent of the cases, primarily because of (false) aneurysm formation. Our series illustrates that late complications are not uncommon, so that rigorous follow-up of these CA patients remains mandatory.status: publishe