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Outcomes after Biventricular Repair Using a Conduit between the Right Ventricle and Pulmonary Artery in Infancy
Dong Hee Jang1, Dong-Hee Kim1,2, Eun Seok Choi1,2
1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Biventricular repair using right ventricle to pulmonary artery (RV-PA) conduits is safe in infants. A conduit z-score of 1.3 may reduce reintervention and dysfunction risks, though many patients still require reintervention.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Cardiovascular Surgery
Background:
- Biventricular repair is a complex procedure for congenital heart defects.
- Right ventricle to pulmonary artery (RV-PA) conduit placement is a critical step in biventricular repair for infants.
- Outcomes in very young patients (<1 year) undergoing RV-PA conduit placement require further investigation.
Purpose of the Study:
- To evaluate the outcomes of biventricular repair using RV-PA conduit in patients younger than 1 year.
- To identify risk factors for mortality, conduit reintervention, and conduit dysfunction in this patient population.
- To determine the optimal conduit size (z-score) to minimize adverse events.
Main Methods:
- Retrospective study of 141 patients (<1 year) undergoing RV-PA conduit placement between 2011-2020.
- Outcomes assessed included all-cause mortality, conduit reintervention, and conduit dysfunction (peak velocity ≥3.5 m/sec or moderate/severe regurgitation).
- Multivariable analysis and analysis of variance were used to identify risk factors and relationships between conduit z-score and outcomes.
Main Results:
- The 5-year survival rate was 89.6%. Younger age and longer cardiopulmonary bypass time were associated with mortality.
- 61 patients (43.3%) required conduit reintervention, and 68 patients (48.2%) experienced conduit dysfunction within 5 years.
- A smaller conduit z-score was a significant risk factor for both reintervention and dysfunction. Optimal z-scores were 1.3 for reintervention and 1.4 for dysfunction.
Conclusions:
- RV-PA conduit placement is a feasible surgical option for infants.
- A substantial proportion of patients require reintervention or develop conduit dysfunction.
- Utilizing a slightly oversized conduit (z-score of 1.3-1.4) may improve long-term outcomes by reducing reintervention and dysfunction rates.
Background:
This study investigated the outcomes of biventricular repair using right ventricle to pulmonary artery (RV-PA) conduit placement in patients aged <1 year.
Methods:
Patients aged <1 year who underwent biventricular repair using an RV-PA conduit between 2011 and 2020 were included in this study. The outcomes of interest were death from any cause, conduit reintervention, and conduit dysfunction (peak velocity of ≥3.5 m/sec or moderate or severe regurgitation).
Results:
In total, 141 patients were enrolled. The median age at initial conduit implantation was 6 months. The median conduit diameter z-score was 1.3. The overall 5-year survival rate was 89.6%. In the multivariable analysis, younger age (p=0.006) and longer cardiopulmonary bypass time (p=0.001) were risk factors for overall mortality. During follow-up, 61 patients required conduit reintervention, and conduit dysfunction occurred in 68 patients. The 5-year freedom from conduit reintervention and dysfunction rates were 52.9% and 45.9%, respectively. In the multivariable analysis, a smaller conduit z-score (p<0.001) was a shared risk factor for both conduit reintervention and dysfunction. Analysis of variance demonstrated a nonlinear relationship between the conduit z-score and conduit reintervention or dysfunction. The hazard ratio was lowest in patients with a conduit z-score of 1.3 for reintervention and a conduit z-score of 1.4 for dysfunction.
Conclusion:
RV-PA conduit placement can be safely performed in infants. A significant number of patients required conduit reintervention and had conduit dysfunction. A slightly oversized conduit with a z-score of 1.3 may reduce the risk of conduit reintervention or dysfunction.
