Aortic root and right ventricular outflow tract replacement with mechanical conduits in adult patients after repeated surgery for congenital heart disease

Objective: The aim of this study was to evaluate the operative results of combined prosthetic aortic root and right ventricular outflow tract (RVOT) replacement in patients after implantation of biological RVOT conduit for congenital heart disease. Methods: The combined procedure was performed in 5 patients (2 truncus arteriosus, 2 variant of tetralogy of Fallot, and a 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 received a median of 3 previous operations and this procedure was their third (in 1), forth (in 3), or fifth (in 1) operation. The mean interval since the previous operation was 8.2 (3–16) years. Results: Mean cardiopulmonary bypass (CPB) and aortic cross-clamp (AXC) time were 354 (248 to 422) and 113 (69 to 142) minutes, respectively. One patient died on the 18 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 maximum of 41 months follow-up. Mechanical valve function in aortic and pulmonary position is good without any thromboembolic or bleeding complication in all surviving patients. Conclusions: Aortic root and RVOT replacement with mechanical conduits for aortic root aneurysm and RVOT graft dysfunction in adult patients with congenital heart disease is a complex operation requiring long CPB and AXC times. However, operative mortality is acceptable and the mid-term outcome is satisfactory.