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Updated: Nov 2, 2025
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Published on: July 18, 2014
Time-Related Risk of Pulmonary Conduit Re-replacement: A Congenital Heart Surgeons' Society Study
Connor P Callahan1, Anusha Jegatheeswaran2, Eugene H Blackstone3
1Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Patients with a second right ventricle to pulmonary artery conduit (PC2) face risks of further procedures. Avoiding aortic homografts and oversizing conduits can reduce the need for subsequent interventions like PC3 or transcatheter pulmonary valve insertion (TPVI).
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Right ventricle to pulmonary artery conduits (PC) implanted in infancy require reintervention due to limited longevity.
- Understanding factors influencing the timing of subsequent procedures is crucial for patient management.
Purpose of the Study:
- To identify factors associated with the time-related risk of a third surgical conduit replacement (PC3) or transcatheter pulmonary valve insertion (TPVI) after a second surgically placed conduit (PC2).
Main Methods:
- A retrospective analysis of 630 patients who received an initial PC (PC1) before age 2.
- Focusing on 355 patients who underwent a second conduit placement (PC2), competing risk and multiphase parametric hazard analyses were employed.
- Data were collected from 29 Congenital Heart Surgeons' Society member institutions between 2002 and 2016.
Main Results:
- In 355 PC2 patients, 65 required PC3 and 41 underwent TPVI, with a median follow-up of 5.3 years.
- Factors increasing PC3 risk included smaller PC2 Z score, concomitant aortic valve intervention, aortic allograft use, younger age at PC2, and larger PC1 Z score.
- Factors increasing TPVI risk included aortic allograft use, porcine unstented conduit, and older age at PC2.
Conclusions:
- Aortic allografts used as PC2 are linked to a higher risk of subsequent PC3 or TPVI.
- Surgeons should consider avoiding aortic homografts for PC2 and oversizing the conduit when feasible to mitigate risks of reintervention.
Background:
Patients receiving a right ventricle to pulmonary artery conduit (PC) in infancy will require successive procedures or replacements, each with variable longevity. We sought to identify factors associated with time-related risk of a subsequent surgical replacement (PC3) or transcatheter pulmonary valve insertion (TPVI) after a second surgically placed PC (PC2).
Methods:
From 2002 to 2016, 630 patients from 29 Congenital Heart Surgeons' Society member institutions survived to discharge after initial valved PC insertion (PC1) at age ≤ 2 years. Of those, 355 underwent surgical replacement (PC2) of that initial conduit. Competing risk methodology and multiphase parametric hazard analyses were used to identify factors associated with time-related risk of PC3 or TPVI.
Results:
Of 355 PC2 patients (median follow-up, 5.3 years), 65 underwent PC3 and 41 TPVI. Factors at PC2 associated with increased time-related risk of PC3 were smaller PC2 Z score (hazard ratio [HR] 1.6, P < .001), concomitant aortic valve intervention (HR 7.6, P = .009), aortic allograft (HR 2.2, P = .008), younger age (HR 1.4, P < .001), and larger Z score of PC1 (HR 1.2, P = .04). Factors at PC2 associated with increased time-related risk of TPVI were aortic allograft (HR: 3.3, P = .006), porcine unstented conduit (HR 4.7, P < .001), and older age (HR 2.3, P = .01).
Conclusions:
Aortic allograft as PC2 was associated with increased time-related risk of both PC3 and TPVI. Surgeons may reduce risk of these subsequent procedures by not selecting an aortic homograft at PC2, and by oversizing the conduit when anatomically feasible.
