Intermediate results after complete repair of XXXX in neonates.

@entity1 @entity215 @entity338 @entity849 @entity358 @entity1146 @entity204
From July 1988 through September 1993, 30 neonates with symptomatic @entity215 underwent complete repair. Sixteen @entity1 had tetralogy and @entity849 , 9 had @entity1146 , 3 had @entity358 , and 2 had both @entity1146 and @entity358 . The median age at operation was 11 days (mean +/- standard error of the mean, 12.6 +/- 2.9 days), with a mean weight of 3.1 +/- 0.1 kg (range 1.5 to 4.4 kg). Preoperatively, 14 @entity1 were receiving an infusion of prostaglandin, 13 were mechanically ventilated, and 6 required inotropic support. Right ventricular outflow tract obstruction was managed by a limited transannular patch in 25 @entity1 , infundibular muscle division with limited resection in 15, and insertion of a right ventricle-pulmonary artery valved aortic homograft conduit in 5 @entity1 . Follow-up was complete at a median interval of 24 months (range 1 to 62 months). There were no hospital @entity204 and two late @entity204 , for 1-month, 1-year, and 5-year actuarial survivals of 100%, 93%, and 93%, respectively. The hazard function for @entity204 had a rapidly declining single phase that approached zero by 6 months after the operation. Both late @entity204 occurred in @entity1 with @entity215 and @entity1146 who had undergone aortic homograft conduit reconstruction, so that the only independent risk factor for @entity204 was the use of a valved homograft conduit (p < or = 0.005). Eight @entity1 required reoperation, resulting in 1-month, 1-year, and 5-year freedom from reoperation rates of 100%, 93%, and 66%, respectively. Indications for reoperation were branch left @entity849 in 5 @entity1 , residual right ventricular outflow tract obstruction in 2 @entity1 , and severe @entity338 in 1 @entity1 . Independent risk factors for reoperation included an intraoperative pressure ratio between the right and left ventricles of 0.75 or greater (p = 0.01), Doppler residual left @entity849 of 15 mm Hg or more, or Doppler right ventricular outflow tract obstruction gradient of 40 mm Hg or more at hospital discharge (p = 0.002 and 0.02, respectively). This series demonstrates the safety of early hemodynamic repair of symptomatic @entity215 in neonates. It also emphasizes the importance of relieving all sources of right ventricular outflow tract obstruction at the initial operation, particularly that located at the site of insertion of the ductus arteriosus, which may be difficult to diagnose in the neonate before ductal closure occurs. The safety and efficacy of valved aortic homograft conduits in neonates requires further investigation.
