Valved Femoral Vein Homografts as Right Ventricle to Pulmonary Artery Conduit for Repair of Truncus Arteriosus

To assess outcomes of early surgical repair of truncus arteriosus by analyzing outcomes with the use of valved femoral vein homografts as right ventricle to pulmonary artery conduit.

Between 2002 and 2023, 51 patients who underwent primary surgical repair for truncus arteriosus were reviewed retrospectively.

Median (interquartile range) age and weight were 7 (5.7-17.5) days and 3 (2.6-3.7) kg. Median follow-up was 7 (3-17) years. Survival was 86% and 81% at 1 and 15 years, respectively. Birth weight below 2 kg, conduit size of 10 mm or smaller, and the need for extracorporeal membrane oxygenation were associated with higher mortality. Valved femoral vein homografts were utilized in 29 (57%, 29 of 51) patients, pulmonary artery homografts in 11 (22%, 11 of 51), aortic homografts in 7 (14%, 7 of 51), valveless tube grafts in 3 (6%, 3 of 51), and a bioconduit in 1 (2%, 1 of 51). Thirty (59%, 30 of 51) patients underwent conduit replacement within a median of 2.7 (1.7-4.8) years. No difference was observed among conduit types based on the time from truncus arteriosus repair to conduit reintervention or replacement (P = .24). Freedom from conduit catheter-based reintervention or replacement was 75%, 59%, and 37% at 1, 2, and 3 years, respectively. Median conduit z-score was smaller in patients with conduit reintervention or replacement within 2 years compared with those after 2 years (2.78 vs 3.8, P = .04).

Valved femoral vein homografts are durable as right ventricle to pulmonary artery conduits in early primary repair of truncus arteriosus. The choice of appropriately sized conduit reduces the rate of reintervention.