Association of pulmonary conduit type and size with durability in infants and young children

Jeffrey A. Poynter, Pirooz Eghtesady, Brian W. McCrindle, Henry L. Walters, Paul M. Kirshbom, Eugene H. Blackstone, S. Adil Husain, David M. Overman, Erle H. Austin, Tara Karamlou, Andrew J. Lodge, James D. St. Louis, Peter J. Gruber, Gerhard Ziemer, Ryan R Davies, Jeffrey P. Jacobs, John W. Brown, William G. Williams, Christo I. Tchervenkov, Marshall L. JacobsChristopher A. Caldarone

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background Treatment of congenital heart disease may include placement of a right ventricle to pulmonary artery conduit that requires future surgical replacement. We sought to identify surgeon-modifiable factors associated with durability (defined as freedom from surgical replacement or explantation) of the initial conduit in children less than 2 years of age at initial insertion. Methods Since 2002, 429 infants were discharged from 24 Congenital Heart Surgeons' Society member institutions after initial conduit insertion. Parametric hazard analysis identified factors associated with conduit durability while adjusting for patient characteristics, the institution where the conduit was inserted, and time-dependent interval procedures performed after conduit insertion but before replacement/explantation. Results In all, 138 conduit replacements (32%) and 3 explantations (1%) were performed. Conduit durability at a median follow-up of 6.0 years (range, 0.1 to 11.7) was 63%. After adjusting for interval procedures and institution, placement of a conduit with smaller z-score was associated with earlier replacement/explantation (p = 0.002). Moreover, conduit durability was substantially reduced with aortic allografts (p = 0.002) and pulmonary allografts (p = 0.03) compared with bovine jugular venous valved conduits (JVVC). The JVVC were 12 mm to 22 mm in diameter at insertion (compared with 6 mm to 20 mm for allografts); therefore, a parametric propensity-adjusted analysis of patients with aortic or pulmonary allografts versus JVVC with diameter of 12 mm or greater was performed, which verified the superior durability of JVVC. Conclusions Pulmonary conduit type and z-score are associated with late conduit durability independent of the effects of institution and subsequent interval procedures. Surgeons can improve long-term conduit durability by judiciously oversizing, and by selecting a JVVC.

Original languageEnglish (US)
Pages (from-to)1695-1702
Number of pages8
JournalAnnals of Thoracic Surgery
Volume96
Issue number5
DOIs
StatePublished - Nov 1 2013

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Neck
Allografts
Lung
Pulmonary Artery
Statistical Factor Analysis
Heart Ventricles
Heart Diseases
Surgeons
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Poynter, J. A., Eghtesady, P., McCrindle, B. W., Walters, H. L., Kirshbom, P. M., Blackstone, E. H., ... Caldarone, C. A. (2013). Association of pulmonary conduit type and size with durability in infants and young children. Annals of Thoracic Surgery, 96(5), 1695-1702. https://doi.org/10.1016/j.athoracsur.2013.05.074

Association of pulmonary conduit type and size with durability in infants and young children. / Poynter, Jeffrey A.; Eghtesady, Pirooz; McCrindle, Brian W.; Walters, Henry L.; Kirshbom, Paul M.; Blackstone, Eugene H.; Husain, S. Adil; Overman, David M.; Austin, Erle H.; Karamlou, Tara; Lodge, Andrew J.; St. Louis, James D.; Gruber, Peter J.; Ziemer, Gerhard; Davies, Ryan R; Jacobs, Jeffrey P.; Brown, John W.; Williams, William G.; Tchervenkov, Christo I.; Jacobs, Marshall L.; Caldarone, Christopher A.

In: Annals of Thoracic Surgery, Vol. 96, No. 5, 01.11.2013, p. 1695-1702.

Research output: Contribution to journalArticle

Poynter, JA, Eghtesady, P, McCrindle, BW, Walters, HL, Kirshbom, PM, Blackstone, EH, Husain, SA, Overman, DM, Austin, EH, Karamlou, T, Lodge, AJ, St. Louis, JD, Gruber, PJ, Ziemer, G, Davies, RR, Jacobs, JP, Brown, JW, Williams, WG, Tchervenkov, CI, Jacobs, ML & Caldarone, CA 2013, 'Association of pulmonary conduit type and size with durability in infants and young children', Annals of Thoracic Surgery, vol. 96, no. 5, pp. 1695-1702. https://doi.org/10.1016/j.athoracsur.2013.05.074
Poynter JA, Eghtesady P, McCrindle BW, Walters HL, Kirshbom PM, Blackstone EH et al. Association of pulmonary conduit type and size with durability in infants and young children. Annals of Thoracic Surgery. 2013 Nov 1;96(5):1695-1702. https://doi.org/10.1016/j.athoracsur.2013.05.074
Poynter, Jeffrey A. ; Eghtesady, Pirooz ; McCrindle, Brian W. ; Walters, Henry L. ; Kirshbom, Paul M. ; Blackstone, Eugene H. ; Husain, S. Adil ; Overman, David M. ; Austin, Erle H. ; Karamlou, Tara ; Lodge, Andrew J. ; St. Louis, James D. ; Gruber, Peter J. ; Ziemer, Gerhard ; Davies, Ryan R ; Jacobs, Jeffrey P. ; Brown, John W. ; Williams, William G. ; Tchervenkov, Christo I. ; Jacobs, Marshall L. ; Caldarone, Christopher A. / Association of pulmonary conduit type and size with durability in infants and young children. In: Annals of Thoracic Surgery. 2013 ; Vol. 96, No. 5. pp. 1695-1702.
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abstract = "Background Treatment of congenital heart disease may include placement of a right ventricle to pulmonary artery conduit that requires future surgical replacement. We sought to identify surgeon-modifiable factors associated with durability (defined as freedom from surgical replacement or explantation) of the initial conduit in children less than 2 years of age at initial insertion. Methods Since 2002, 429 infants were discharged from 24 Congenital Heart Surgeons' Society member institutions after initial conduit insertion. Parametric hazard analysis identified factors associated with conduit durability while adjusting for patient characteristics, the institution where the conduit was inserted, and time-dependent interval procedures performed after conduit insertion but before replacement/explantation. Results In all, 138 conduit replacements (32{\%}) and 3 explantations (1{\%}) were performed. Conduit durability at a median follow-up of 6.0 years (range, 0.1 to 11.7) was 63{\%}. After adjusting for interval procedures and institution, placement of a conduit with smaller z-score was associated with earlier replacement/explantation (p = 0.002). Moreover, conduit durability was substantially reduced with aortic allografts (p = 0.002) and pulmonary allografts (p = 0.03) compared with bovine jugular venous valved conduits (JVVC). The JVVC were 12 mm to 22 mm in diameter at insertion (compared with 6 mm to 20 mm for allografts); therefore, a parametric propensity-adjusted analysis of patients with aortic or pulmonary allografts versus JVVC with diameter of 12 mm or greater was performed, which verified the superior durability of JVVC. Conclusions Pulmonary conduit type and z-score are associated with late conduit durability independent of the effects of institution and subsequent interval procedures. Surgeons can improve long-term conduit durability by judiciously oversizing, and by selecting a JVVC.",
author = "Poynter, {Jeffrey A.} and Pirooz Eghtesady and McCrindle, {Brian W.} and Walters, {Henry L.} and Kirshbom, {Paul M.} and Blackstone, {Eugene H.} and Husain, {S. Adil} and Overman, {David M.} and Austin, {Erle H.} and Tara Karamlou and Lodge, {Andrew J.} and {St. Louis}, {James D.} and Gruber, {Peter J.} and Gerhard Ziemer and Davies, {Ryan R} and Jacobs, {Jeffrey P.} and Brown, {John W.} and Williams, {William G.} and Tchervenkov, {Christo I.} and Jacobs, {Marshall L.} and Caldarone, {Christopher A.}",
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T1 - Association of pulmonary conduit type and size with durability in infants and young children

AU - Poynter, Jeffrey A.

AU - Eghtesady, Pirooz

AU - McCrindle, Brian W.

AU - Walters, Henry L.

AU - Kirshbom, Paul M.

AU - Blackstone, Eugene H.

AU - Husain, S. Adil

AU - Overman, David M.

AU - Austin, Erle H.

AU - Karamlou, Tara

AU - Lodge, Andrew J.

AU - St. Louis, James D.

AU - Gruber, Peter J.

AU - Ziemer, Gerhard

AU - Davies, Ryan R

AU - Jacobs, Jeffrey P.

AU - Brown, John W.

AU - Williams, William G.

AU - Tchervenkov, Christo I.

AU - Jacobs, Marshall L.

AU - Caldarone, Christopher A.

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Background Treatment of congenital heart disease may include placement of a right ventricle to pulmonary artery conduit that requires future surgical replacement. We sought to identify surgeon-modifiable factors associated with durability (defined as freedom from surgical replacement or explantation) of the initial conduit in children less than 2 years of age at initial insertion. Methods Since 2002, 429 infants were discharged from 24 Congenital Heart Surgeons' Society member institutions after initial conduit insertion. Parametric hazard analysis identified factors associated with conduit durability while adjusting for patient characteristics, the institution where the conduit was inserted, and time-dependent interval procedures performed after conduit insertion but before replacement/explantation. Results In all, 138 conduit replacements (32%) and 3 explantations (1%) were performed. Conduit durability at a median follow-up of 6.0 years (range, 0.1 to 11.7) was 63%. After adjusting for interval procedures and institution, placement of a conduit with smaller z-score was associated with earlier replacement/explantation (p = 0.002). Moreover, conduit durability was substantially reduced with aortic allografts (p = 0.002) and pulmonary allografts (p = 0.03) compared with bovine jugular venous valved conduits (JVVC). The JVVC were 12 mm to 22 mm in diameter at insertion (compared with 6 mm to 20 mm for allografts); therefore, a parametric propensity-adjusted analysis of patients with aortic or pulmonary allografts versus JVVC with diameter of 12 mm or greater was performed, which verified the superior durability of JVVC. Conclusions Pulmonary conduit type and z-score are associated with late conduit durability independent of the effects of institution and subsequent interval procedures. Surgeons can improve long-term conduit durability by judiciously oversizing, and by selecting a JVVC.

AB - Background Treatment of congenital heart disease may include placement of a right ventricle to pulmonary artery conduit that requires future surgical replacement. We sought to identify surgeon-modifiable factors associated with durability (defined as freedom from surgical replacement or explantation) of the initial conduit in children less than 2 years of age at initial insertion. Methods Since 2002, 429 infants were discharged from 24 Congenital Heart Surgeons' Society member institutions after initial conduit insertion. Parametric hazard analysis identified factors associated with conduit durability while adjusting for patient characteristics, the institution where the conduit was inserted, and time-dependent interval procedures performed after conduit insertion but before replacement/explantation. Results In all, 138 conduit replacements (32%) and 3 explantations (1%) were performed. Conduit durability at a median follow-up of 6.0 years (range, 0.1 to 11.7) was 63%. After adjusting for interval procedures and institution, placement of a conduit with smaller z-score was associated with earlier replacement/explantation (p = 0.002). Moreover, conduit durability was substantially reduced with aortic allografts (p = 0.002) and pulmonary allografts (p = 0.03) compared with bovine jugular venous valved conduits (JVVC). The JVVC were 12 mm to 22 mm in diameter at insertion (compared with 6 mm to 20 mm for allografts); therefore, a parametric propensity-adjusted analysis of patients with aortic or pulmonary allografts versus JVVC with diameter of 12 mm or greater was performed, which verified the superior durability of JVVC. Conclusions Pulmonary conduit type and z-score are associated with late conduit durability independent of the effects of institution and subsequent interval procedures. Surgeons can improve long-term conduit durability by judiciously oversizing, and by selecting a JVVC.

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