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Outcomes of Prosthetic Valved Conduits for Right Ventricular Outflow Tract Reconstruction

Hao Chen1, Guocheng Shi1, Lisheng Qiu1

  • 1Department of Cardio-thoracic Surgery, Heart Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong New District, Shanghai, China.

Pediatric Cardiology
|March 20, 2019
PubMed

Insights

This study analyzed prosthetic valved conduits for pediatric right outflow tract reconstruction in China. While survival is good, reintervention rates are high, particularly with smaller conduits and prior palliative surgery.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Biomaterials Science

Background:

  • Limited data exists on prosthetic valved conduit use for pediatric right outflow tract reconstruction in China.
  • Right outflow tract reconstruction is critical for congenital heart defect management.

Purpose of the Study:

  • To evaluate the outcomes of prosthetic valved conduits for right outflow tract reconstruction in Chinese pediatric patients.
  • To identify risk factors for mortality, reintervention, and endocarditis following conduit implantation.

Main Methods:

  • Retrospective review of 128 pediatric patients who underwent conduit implantation between 2009 and 2018.
  • Analysis of mortality, reintervention, and endocarditis using multivariate Cox regression and Kaplan-Meier curves.
  • Median follow-up of 33.3 months.

Main Results:

  • Hospital mortality was 7.8%, with a 10-year patient survival of 84.3%.
  • Freedom from reintervention at 1 and 5 years was 94.1% and 60.9%, respectively. Small conduit size and previous palliation predicted reintervention.
  • Endocarditis occurred in 10 conduits, with freedom from endocarditis at 1, 5, and 10 years at 99.1%, 93.0%, and 58.0%. Conduit stenosis was a risk factor for late endocarditis.

Conclusions:

  • Prosthetic valved conduits, including bovine jugular venous and pericardial options, show acceptable outcomes in pediatric right outflow tract reconstruction.
  • High reintervention rates are associated with smaller conduit size and prior palliative procedures.
  • Suboptimal flow may contribute to the development of late endocarditis.

Keywords:
Congenital heart diseaseEndocarditisProsthetic valved conduitsRight ventricular outflow tract reconstructionRisk factors

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