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.
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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)
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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)
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