Volume : VII, Issue : XI, November - 2017

Right ventricular outflow tract reconstruction with a patch: A systematic review

Dr Rakesh Kumar

Abstract :

 A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed is: When using a pericardial patch for reconstruction of the right ventricular outflow tract, is an untreated patch or a patch treated with glutaraldehyde better? 36 papers were found using the pub med search, of which 3 papers (1 human and 2 animal studies) represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We included papers that compared fresh untreated autologous pericardial patch with glutaraldehyde treated pericardial patch. We excluded papers that did not compare these two and assessed either one of them alone.  In the only available human study compå outcomes in children undergoing complete transventricular repair for Tetralogy of Fallot (TOF) and RVOT reconstruction with either types of pericardium, it was found that. There was no significant difference in post repair hemodynamics, incidence of transannular patching, or in systolic RVOT pressures. However at 6 months of follow–up, 72% of the patients with untreated patches had a significant increase in the RVOT diameters as indexed to the aortic annulus. In patients with glutaraldehyde treated patches, only one patient had increased RVOT diameters. In the other two experimental studies in animals, there was a lower incidence of pulmonary regurgitation and RVOT aneurysm formation at follow up. This seems to indicate that patients who received glutaraldehyde treated pericardium had a lower incidence of dilation of the right ventricular outflow tract and a lesser incidence of pulmonary regurgitation than non–fixed fresh pericardium. The search for optimal patch material is an ongoing challenge in congenital heart surgery (CHS). In this study, we report our first experience with the use of a novel decellularized bovine pericardial patch material (CardioCel™) for different applications in CHS. Retrospective review of our institutional experience with CardioCel™. Patient diagnoses ranged from valve lesions (e.g., bicuspid aortic valves, Ebstein anomaly, common AV–valve), septal defects (e.g., VSD), conotruncal lesions (e.g., tetralogy of fallot, TGA) and univentricular hearts (e.g., hypoplastic left heart syndrome). Operative details and early postoperative outcome parameters were used to identify graft–related morbidity. Echocardiographic results at discharge were used for the assessment of graft appearance and performance. Data are presented as median values (range). This study demonstrates excellent early results for CardioCel™ patch. Implantation was free of tissue related complications and applicable for manifold indications in complex congenital cardiac repairs.

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Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

Dr Rakesh Kumar, Right ventricular outflow tract reconstruction with a patch: A systematic review, INDIAN JOURNAL OF APPLIED RESEARCH : Volume-7 | Issue-11 | November-2017

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