Background: Various diseases, ages, and diagnostic/therapeutic options hamper long-term comparisons of valved conduits. Raw data pooling of two high volume sites considering all these facts gives new insights.

Objectives: Decellularized homografts (DH), which have shown promising early results in pulmonary valve replacement in children and young adults, could potentially avoid significant activation of the immune system, as more than 99% of donor DNA is removed during the decellularization process. The aim of this study was to evaluate whether implantation of a fresh decellularized human allograft induces a cellular immune response.

Background: Homografts have limited durability and degenerate early especially in young patients. After encouraging experience with a small series in pulmonary position, we began to implant decellularized fresh pulmonary homografts (DPH) in lager quantities.

Background: Homografts have limited durability and degenerate early especially in young patients. After encouraging experience with decellularized homografts (DH) in pulmonnary position, we started implanting them in the aortic position.

Objectives: According to the increasing number of grown-up congenital heart patients, late development of aortic aneurysm is now recognized. However, there are few reports about etiology, operative indications, and surgical treatment of aortic aneurysm associated with congenital heart disease (CHD).

Objectives: The surgical management of patients with complete transposition of the great arteries (TGA) has changed from atrial to arterial switch operation. We evaluated long-term outcome of all patients that underwent surgical repair of TGA at our institution.

Background: Despite the improvement of perioperative mortality, functional deterioration late after Fontan operation still remains a relevant clinical issue. This study evaluates long-term outcome after Fontan operation.

Background: Bovine jugular vein (BJV) valves have a higher profile than homografts. The impact of stress on their hemodynamics, especially valve insufficiency, is unclear. So we exposed 20 recipients (age 7.9–19.6 years, mean 14.8±2.9, median 15.5) with well working conduits in pulmonary position to cycle ergometry stress. Valve function was measured with MRI and Doppler immediately after stress cessation.

OBJECTIVE:To manage aortic root aneurysms and right ventricular outflow tract (RVOT) graft dysfunction in adult patients after repeated surgery for congenital heart disease, we performed combined prosthetic aortic root and RVOT replacement.METHODS:The procedure was performed in 5 patients (2 truncus arteriosus, 2 variants of tetralogy of Fallot, and 1 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 undergone a median of 3 previous operations and this procedure was their third (in 1), fourth (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-clamping (AXC) times were 354 (248-422) and 113 (69-142) minutes, respectively. One patient died on the 16th 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 a maximum of 41 months follow-up. Mechanical valve function in the aortic and pulmonary position is good without any thromboembolic or bleeding complications in all surviving patients.CONCLUSIONS:Combined aortic root and RVOT replacement with mechanical conduits in adult patients after repeated surgery for congenital heart disease is a complex operation requiring long CPB time. However, this procedure has the potential to avoid a predictable reoperation associated with conventional biological graft replacement.

Objective: Methods: Results: Conclusion:

Objective: This study evaluated the historical impact on outcome for early primary repair for complete atrioventricular septal defect (CAVSD) in our institute.

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.

Pediatric cardiopulmonary bypass is still a challenge because of electrolyte disturbances and inflammation. Many investigations deal with different types of hemofiltration to reduce these potentially harmful side effects. We tested the hypothesis of whether bicarbonate-buffered hemofiltration of the priming solution minimizes electrolyte and acid-base disturbances during the initiation of cardiopulmonary bypass and whether bicarbonate-buffered hemofiltration performed during cardiopulmonary bypass could reduce cytokine levels. Twenty children younger than 2 years of age (mean age 166 ± 191 days; mean weight 6.42 ± 3.22 kg) scheduled for pediatric cardiac surgery with cardiopulmonary bypass were enrolled in this prospective clinical study. Cardiopulmonary bypass circuits were primed with a bicarbonate-buffered hemofiltration solution, gelatin and 1 unit of packed red blood cells. The priming was hemofiltered using an ultrahemofilter until approximately 1000 mL of ultrafiltrate was restored with the buffered solution. Further hemofiltration was performed throughout the whole bypass time, especially during rewarming. Blood gas analyses and inflammatory mediators were monitored during the operation. Blood gas analysis results after initiation of cardiopulmonary bypass and throughout the entire study remained within the physiologic ranges. Even potassium decreased from 4.0 ± 0.3 to 3.4 ± 0.4 mmol.l −1 after initiation of cardiopulmonary bypass. Plasma levels of tumor necrosis factor alpha decreased significantly (47 ± 44 vs. 24 ± 21 pg.mL −1 ) whereas complement factor C3a (5.0 ± 2.9 vs. 16.8 ± 6.6 ng.mL −1 ) and interleukin-6 (7.3 ± 15.2 vs. 110 ± 173 pg.mL −1 ) increased despite hemofiltration. In conclusion, this study shows that bicarbonate-buffered ultrafiltration is an efficient, simple and safe method for performing hemofiltration, both of the priming solution and during the entire bypass time. The use of a physiological restitution solution prevents electrolyte and acid-base balance disturbances. The elimination of inflammatory mediators seems to be as effective as other ultrafiltration methods.

OBJECTIVE:The valved bovine conduit "Contegra" for RVOT reconstruction became available for clinical use within a 100 % source data monitored and echo core lab controlled prospective European Multicentre Study, carried out from 1999 to 2006. We present the results of this study.METHODS:A total of 165 Contegras were implanted in 8 centres. The mean patient age was 3.9 years (2 days - 18 years, median 2.0). Total follow-up was 687 patient years. Diagnoses included: tetralogy of Fallot (64 patients, 39 %), truncus arteriosus (50, 30 %), double outlet right ventricle (16, 10 %), aortic valve disease/Ross procedure (11, 7 %), pulmonary valve atresia (10, 6 %), transposition of the great arteries (10, 6 %), 4 other malformations (2 %). Previous procedures were: 82 patients (50 %) - none; 37 (22 %) - valved conduit implantation; 14 (8 %) aortopulmonary shunt; 6 (4 %) catheter intervention. Follow-up appointments which included standardised echocardiography investigations were scheduled at 1, 3, 6, and 12 months, then annually. We evaluated freedom from death, explantation, intervention, stenosis, insufficiency, and degeneration. Results were stratified by age, diagnosis group and conduit size.RESULTS:The 5-year freedom-from rates were: explantation - 90 % (for patients aged 1 to 10 years) and 68 % (for younger patients); endocarditis - over 92 %; catheter intervention - 74 % (patients with congenital malformations); stenosis - 75 % and more (any group); insufficiency - 50 % (12 and 14 mm diameter conduits); any event - 13 % (patients under 1 year), 58 % (1 to 10 years), 82 % (> 10 years). Trace or mild insufficiency was a frequent, but not progressive finding. Mild calcification was detected in only 8 examinations.CONCLUSIONS:The performance of the Contegra conduit compares well with that of homografts when used to reconstruct paediatric right ventricular outflow tracts.

Objectives: Here, we report about our first clinical experience of cell-free Pulmonary Valves (PV) implantations in paediatric patients and the results of early and mid-term follow-up.