Jeffrey A. Poynter, MD, Pirooz Eghtesady, MD, PhD, Brian W

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Presentation transcript:

Association of Pulmonary Conduit Type and Size With Durability in Infants and Young Children Jeffrey A. Poynter, MD, Pirooz Eghtesady, MD, PhD, Brian W. McCrindle, MD, Henry L. Walters, MD, Paul M. Kirshbom, MD, Eugene H. Blackstone, MD, S. Adil Husain, MD, David M. Overman, MD, Erle H. Austin, MD, Tara Karamlou, MD, Andrew J. Lodge, MD, James D. St. Louis, MD, Peter J. Gruber, MD, PhD, Gerhard Ziemer, MD, PhD, Ryan R. Davies, MD, Jeffrey P. Jacobs, MD, John W. Brown, MD, William G. Williams, MD, Christo I. Tchervenkov, MD, Marshall L. Jacobs, MD, Christopher A. Caldarone, MD The Annals of Thoracic Surgery Volume 96, Issue 5, Pages 1695-1702 (November 2013) DOI: 10.1016/j.athoracsur.2013.05.074 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Freedom from explantation (durability) of the initial 429 conduits plotted against time since conduit insertion. Parametrically modeled conduit durability is 53% (70% confidence interval: 49% to 56%) at 8 years after insertion. Each circle represents an explantation; vertical lines are asymmetric confidence limits of 1 SE (68%); numbers in parentheses are children remaining at risk; the solid line is the parametric estimate enclosed in dashed 68% confidence limits. The Annals of Thoracic Surgery 2013 96, 1695-1702DOI: (10.1016/j.athoracsur.2013.05.074) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Durability at 8 years after insertion versus conduit z-score. Durability of bovine jugular venous valved conduits (JVVC) is superior to that of nondecellularized pulmonary allografts (PA [p = 0.02]) and aortic allografts (AA [p < 0.001]) across the full range of conduit z-scores. Larger indexed conduit size is associated with improved durability, regardless of conduit type. The Annals of Thoracic Surgery 2013 96, 1695-1702DOI: (10.1016/j.athoracsur.2013.05.074) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Prediction plot depicting durability for a child who received an aortic allograft with z-scores ranging from −1 to +4 (shown to the right of each line). Without altering other factors, oversizing with a large conduit (z-score +4) instead of inserting a small-for-size conduit (z-score −1) improves 8-year durability from 25% to 59% (assuming the child can accommodate both sizes). The Annals of Thoracic Surgery 2013 96, 1695-1702DOI: (10.1016/j.athoracsur.2013.05.074) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Prediction plot comparing propensity-adjusted durability of bovine jugular venous valved conduits (JVVC [blue]) and nondecellularized aortic or pulmonary allografts (green) with a z-score of 0 inserted into children without other risk factors. The prediction plot is limited to JVVC or allografts of diameter 12 mm or more (n = 279) to eliminate selection bias due to a smaller minimum diameter for allografts (6 mm) than for JVVC (12 mm). The JVVC exhibit greater durability at 8 years after insertion (p < 0.01). The Annals of Thoracic Surgery 2013 96, 1695-1702DOI: (10.1016/j.athoracsur.2013.05.074) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Solution of the parametric equation illustrating the durability of a nondecellularized aortic allograft with z-score +2 inserted in a child with no other risk factors, who underwent two successive conduit stentings at 1 year and 4 years after insertion. The solid line depicts predicted durability over years since conduit insertion on the x-axis. Dotted lines denote predicted durability in a child who did not undergo the first or second conduit stenting procedures. Each stenting is associated with an approximate 18% reduction in 8-year durability. The Annals of Thoracic Surgery 2013 96, 1695-1702DOI: (10.1016/j.athoracsur.2013.05.074) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Predicted durability of bovine jugular venous valved conduits (JVVC [blue]), nondecellularized pulmonary allografts (PA [green]), or nondecellularized aortic allografts (AA [red]) inserted into children without other risk factors. Solid lines indicate durability when the conduit did not undergo interval stenting; dashed lines are predicted durability if one interval stenting was performed. Reduction in durability associated with interval stenting is similar among all conduit types (p = 0.08). The Annals of Thoracic Surgery 2013 96, 1695-1702DOI: (10.1016/j.athoracsur.2013.05.074) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions