Long-term course after pediatric right ventricular outflow tract reconstruction

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Biomaterials in Medicine

Background:

• Valved homografts are standard for right ventricular outflow tract (RVOT) reconstruction in pediatric patients.
• Existing homografts demonstrate limitations in long-term durability, necessitating further investigation into their performance.
• Understanding factors influencing RVOT conduit longevity is crucial for improving patient outcomes.

Purpose of the Study:

• To compare the single-center outcomes of three RVOT conduit types: aortic homografts, pulmonic homografts, and Contegra conduits.
• To evaluate patient survival, graft failure rates, and reoperation frequency.
• To identify risk factors associated with reoperation in pediatric patients undergoing RVOT reconstruction.

Main Methods:

• Retrospective review of 143 pediatric patients who received RVOT conduit implantation between 2006 and 2018.
• Conduits were stratified into aortic homografts (n=74), pulmonic homografts (n=61), and Contegra (n=8).
• Analysis included patient demographics, diagnosis, graft size, and endpoints such as freedom from graft failure, reoperation, and survival.

Main Results:

• Ten-year survival rate was 83.2%.
• Freedom from graft failure at 10 years was 63.4%.
• Ten-year freedom from reoperation was 85.8% for pulmonic homografts and 74.9% for aortic homografts; Contegra showed 100% freedom at 6 years. Conduit diameter <18mm was a significant risk factor for reoperation (HR 3.16, p=0.007).

Conclusions:

• Homograft valves provide excellent long-term durability and survival for RVOT reconstruction.
• Small conduit diameter (<18mm) is the primary adverse factor affecting graft longevity.
• Reoperation rates for conduit failure did not significantly differ between the studied conduit types.