TITLE

Outcomes following non-valved autologous reconstruction of the right ventricular outflow tract in neonates and infants

AUTHOR(S)
Derby, Christopher D.; Kolcz, Jacek; Gidding, Samuel; Pizarro, Christian
PUB. DATE
October 2008
SOURCE
European Journal of Cardio-Thoracic Surgery;Oct2008, Vol. 34 Issue 4, p726
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Abstract: Objective: Controversy surrounds the optimal method of establishing right ventricle to pulmonary artery continuity in neonates and infants with congenital heart disease. We reviewed our experience with non-valved autologous reconstruction of the right ventricular outflow tract to determine mid-term outcome and risk factors for reintervention. Methods: Between 1998 and 2006, 34 consecutive patients underwent non-valved autologous right ventricular outflow tract reconstruction. The need for postoperative catheter-based intervention or reoperation was assessed using relevant patient and procedure-related variables. Results: Diagnoses included tetralogy of Fallot with anomalous coronary (n =3), tetralogy of Fallot with pulmonary atresia (n =10), truncus arteriosus communis (n =15), and other (n =6). Median age at surgery was 5 days (1–270 days). Twenty-six (76%) patients were neonates. Median weight was 3.1kg (1.8–7.3kg). At a median follow-up of 43 months (1–90 months), 15 (50%) patients underwent reoperation and 7 (23%) underwent catheter-based intervention, with a total of 16 (53%) undergoing either reoperation or catheter-based intervention. Kaplan–Meier freedom from reintervention at 6 months, 1 year, 3 years, and 5 years was 67%, 47%, 47%, and 35% for truncus arteriosus versus 87%, 82%, 68%, and 65% for diagnoses other than truncus arteriosus (p =0.05). Conclusions: Mid-term outcome following non-valved autologous reconstruction of the right ventricular outflow tract is satisfactory and constitutes a sound alternative to the use of small-diameter conduits in neonates and infants. In our hands, this strategy favors certain anatomic subtypes. Non-truncus patients have significantly lower rates of reintervention. Technical details associated with the anatomical reconstruction of the posterior autologous pathway may play an important role in outcomes.
ACCESSION #
34649548

 

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