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

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.

• Authors: Christopher D Derby, Jacek Kolcz, Samuel Gidding, Christian Pizarro
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 34 Issue 4 Pg. 726-31 (Oct 2008) ISSN: 1873-734X [Electronic] Germany
• PMID: 18678511 (Publication Type: Journal Article)

Topics

• Epidemiologic Methods
• Heart Defects, Congenital (surgery)
• Humans
• Infant
• Infant, Newborn
• Pulmonary Atresia (surgery)
• Reoperation
• Tetralogy of Fallot (surgery)
• Transposition of Great Vessels (surgery)
• Treatment Outcome
• Truncus Arteriosus, Persistent (surgery)
• Ventricular Outflow Obstruction (surgery)