The right ventricle to pulmonary artery connection: when homografts are not always available

Aortic or pulmonary homografts are currently the most popular conduits for correction of right ventricle to pulmonary artery (RV-PA) discontinuity. Problems of nonavailability or limited supply in developing countries, however, necessitate recourse to other forms of repair. Forty-nine patients of 72 with RV-PA discontinuity underwent repair without use of a homograft at our institution over a 5-year period. Handmade pericardial valved conduits (n = 18), nonvalved tubes (n = 13), and nonconduit procedures like the REV operation (n = 11) and extended pericardial gusset (n = 5) were mainly used. The choice of procedure was governed by various factors including type of cardiac defect, pulmonary artery pressure and morphology, previous operation, and socioeconomic constraints. Extracardiac conduits do not provide a permanent solution to the problem of RV-PA discontinuity, and efforts to innovate and refine nonconduit procedures must continue.