Calcification in GORE TEX vascular grafts increases with time post-Fontan surgery, detectable by CT, and areas without calcification remain puncturable.
Does the age of GORE TEX vascular grafts after Fontan surgery affect their mechanical puncture properties, calcification, and CT values compared to unused grafts?
GORE TEX vascular grafts develop calcification over time after Fontan surgery, increasing puncture resistance and highlighting the need for pre-procedural CT imaging to identify non-calcified areas for safe trans-conduit puncture.
Absolute Event Rate: 0% vs 0%
Abstract Background The number of cases in which extracardiac conduits are punctured during arrhythmia treatment and fenestration creation after Fontan surgery is increasing. There is a possible risk of embolism in cases where the conduit is stiff and difficult to puncture, or of endarterectomy and embolism following puncture. However, there are no reports on the postoperative conduit properties. The aim of the present study was to determine the conduit properties over time. Subjects and methods Patients who underwent reoperation after Fontan surgery and whose conduits could be harvested were included. (i) pathological assessment, (ii) weighting at conduit puncture and (iii) maximum CT value (Houns field unit). Puncture was performed manually using a Brockenbrough needle and the weighting associated with the puncture was measured. An unused vascular graft was also performed for comparison. Results There were 13 post-Fontan surgery patients (12 extracardiac conduits, 1 intracardiac conduit), 7 women, median age at conduit removal 8 years (2-30 years) and 9 years (75-9207 days) from conduit implantation to removal. Vascular graft included stretch vascular graft in 11 cases, ringed vascular graft in 1 case and patch in 1 case. (i) Calcification was observed in 6 cases. (ii) The weighting at puncture was 955 g (median) and 1310 g (maximum) in unused prostheses and 1140 g (760-1507 g) median and 1420 g (940-2750 g) maximum in Fontan ; (iii) The maximum CT value was 386 HU (279-1167). There was a weak positive correlation between maximum weighting at puncture and the time from conduit implantation to removal; significant differences were found between CT values and the presence of calcification. Conclusions Calcification was observed with age of the GORE TEX vascular graft and was associated with CT values. However, calcification did not occur uniformly in the grafts and puncture was considered possible in areas without calcification. When puncturing conduits, it is important to ascertain the presence of calcification beforehand by CT. In addition, calcification is always present in vascular graft if it has been many years since the Fontan surgery, and care should be taken to avoid cerebral embolism at the time of puncture.
Aoki et al. (Sat,) reported a other. Calcification in GORE TEX vascular grafts increases with time post-Fontan surgery, detectable by CT, and areas without calcification remain puncturable.