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Right ventricle to pulmonary artery conduit augmentation compared with replacement in young children
Justin P V Zachariah1, Frank A Pigula, John E Mayer
1Departments of Cardiology and Cardiac Surgery, Children's Hospital Boston, Boston, Massachusetts 0211, USA.
Insights
Conduit augmentation in children undergoing reoperation offers similar outcomes to replacement, though smaller children and conduits may need earlier reoperation. This study analyzed 180 young patients comparing these surgical approaches.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Vascular Grafting
Background:
- Limited data exists on outcomes for young children needing repeat right ventricle to pulmonary artery conduit surgery.
- Conduit augmentation is an alternative to replacement during the first reoperation (conduit 2), but its effectiveness is not well-documented.
Purpose of the Study:
- To compare clinical outcomes of conduit replacement versus augmentation in children under 10 years undergoing their first conduit reoperation.
- To identify factors influencing reoperation or reintervention rates after conduit surgery.
Main Methods:
- Retrospective chart review of 180 children (<10 years) undergoing first conduit reoperation.
- Comparison of conduit replacement (n=147) versus conduit augmentation (n=33).
- Analysis of baseline, operative, and follow-up data, including reoperation and reintervention rates.
Main Results:
- No significant differences in age, size, or hemodynamics between augmentation and replacement groups.
- Longer cardiopulmonary bypass time for replacement (101 min) vs. augmentation (71 min).
- 10-year survival was 95%; 5-year freedom from reoperation was 80%, 10-year was 39%. No group differences in survival or freedom from reintervention.
- Smaller children and undersized conduits were associated with shorter freedom from reoperation and reintervention.
Conclusions:
- Conduit augmentation is a viable option with similar outcomes to replacement in selected pediatric patients.
- Freedom from reoperation is reduced in smaller children and with undersized conduits after initial replacement.
Background:
Targeted outcome data for young children undergoing right ventricle to pulmonary artery conduit reoperation are sparse, as are data on the use of conduit augmentation as an alternative to conduit replacement at the time of first conduit reoperation (conduit 2).
Methods:
We conducted a retrospective chart review including baseline data, operative data, and cross-sectional follow-up on children younger than 10 years of age undergoing a first conduit reoperation (n = 180), comparing conduit replacement (n = 147, 82%) with conduit augmentation (n = 33, 18%).
Results:
There were no differences between the two groups with respect to age, size, or hemodynamic variables. Augmentation was less often performed in patients with an aortic homograft and by one surgeon. At conduit 2, cardiopulmonary bypass time was longer in replacement patients (101 +/- 35 versus 71 +/- 34 minutes; p < 0.001); cardiac intensive care unit stay was not different. Early mortality was 0.5%, and overall 10-year survival was 95%. Freedom from reoperation was 80% at 5 years and 39% at 10 years, whereas freedom from reintervention (reoperation or catheter intervention) was 55% at 5 years and 26% at 10 years, with no differences between groups. Aortic homograft as a first conduit was associated with shorter freedom from reoperation. Limiting analysis to conduits that were replaced at conduit 2, undersized conduits were associated with shorter freedom from reoperation and smaller body surface area, and undersized conduits were associated with shorter freedom from reintervention.
Conclusions:
Freedom from a second conduit reoperation after a first conduit replacement was shorter in smaller children and undersized conduits. Conduit augmentation offers similar clinical outcomes in selected patients.
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