121 © 2007, the Authors Journal compilation © 2007, Blackwell Publishing, Inc. Congenit Heart Dis. 2007;2:121–124 Blackwell Publishing IncMalden, USACHDCongenital Heart Disease1747-079X© 2007 The Authors; Journal compilation © 2007 Blackwell Publishing, Inc.? 200722121124Original Article Fate of Equine Pericardial Roll Conduit for Rastelli OperationTakeuchi et al. Fate of Equine Pericardial Roll Conduit for Rastelli Operation during Long-term Follow-up Koh Takeuchi, MD,* † Arata Murakami, MD,* Akihiko Sekiguchi, MD, † Yasutaka Hirata, MD,* Katsuhide Maeda, MD,* Kazuo Kitahori, MD,* Yoshio Doi, MD,* and Shin-ichi Takamoto, MD* *Department of Cardiac Surgery, University of Tokyo Graduate of Medical School, Tokyo, Japan; † Department of Cardiovascular Surgery, National Children’s Hospital, Tokyo, Japan ABSTRACT Background. Right ventricular outflow tract obstruction is a frequent condition after Rastelli operation. Although several modifications have been reported elsewhere, ideal conduit has not been developed yet during long-term follow-up. We reviewed our experiences over 15-year long-term follow-up with patients who underwent Rastelli operation using house-made equine pericardial roll graft. Methods. Since June 1981, 16 patients underwent Rastelli operation with the pericardial roll graft. Median follow- up time was 15.6 years (7.3–26.8 years). Results. Twelve out of 16 patients using pericardial roll graft with (n = 6) or without (n = 6) cusps underwent 13 reoperations during the follow-up period. Median time from first Rastelli to re-do operation was 8.4 years with median time to reoperation of 8 years. Major indication for reoperation was conduit obstruction (n = 10), but not conduit regurgitation. Conduit problem includes kinking and compression of the graft. Reoperation procedures include 7 Danielson procedures, 2 patch augmentations, 1 homograft replacement, 1 pericardial roll graft, 1 expanded polytetrafluoroethylene tube graft replacement, and 1 patch closure for pulmonary artery aneurysm. Balloon angioplasty was not effective for pericardial roll conduit stenosis. Conclusion. We conclude that house-made equine pericardial roll graft was durable for certain time period, but conduit change may be inevitable. Because of excellent handling and wide application, further modification may be warranted. Key Words. RV Outflow Tract Obstruction; Conduit Stenosis; Rastelli Operation; Danielson Procedure Introduction ulmonary regurgitation after valveless repair of right ventricle outflow tract obstruction (RVOTO) results in progressive right ventricle (RV) dilation and dysfunction. 1 Valved conduit may clear this problem to some extent, then valve dysfunction or valvular stenosis can occur. Con- duit stenosis can be another potential problem after right ventricle outflow tract (RVOT) repair. Multiple technical modifications have been reported to deal with these problems, but so far no such gold standard technique has been established yet. Many modifications including homograft replacement, synthetic tube graft replacement with or without prosthetic valve, 2 and pericardial patch augmentation with or with- out réparation à l’ótage ventriculaire (REV) procedure 3 have been reported elsewhere. Recently, excellent short-term result with pericar- P dial roll graft has been reported. We have used several conduits for Rastelli operation including house-made pericardial roll graft with cusps as a preferred technique. During the over 15-year median follow-up, we have experienced 16 patients who underwent Rastelli operation with house- made pericardial roll graft. The purpose of this study was to find the potential problems related to the pericardial roll graft in Rastelli operation dur- ing the long-term follow-up and optimal repair for developing RVOTO after Rastelli operation. Materials and Methods Since June 1981, 16 patients underwent Rastelli operation with house-made pericardial roll tube graft with or without cusps for RV outflow tract repair in University of Tokyo Hospital and National Children’s Hospital (Figure 1). All